Teenage pregnancy has long been a topic of concern and controversy in the United States. On one hand it has been characterized as an "epidemic," and President Clinton referred to teen pregnancy as "our most serious social problem" in his 1995 State of the Union Address. Conversely, some research evidence suggests that young maternal age may not be the cause of all adverse consequences commonly associated with teen pregnancy. This article discusses the incidence of teenage pregnancy and trends in birth rates, research on the consequences of teen childbearing for mothers and their children, and the implications of these findings for current policy and intervention strategies.
Incidence of Teenage Pregnancy
Teenage pregnancy rates include those pregnancies that result in live births as well as those ending in induced abortions or other fetal losses. The National Center for Health Statistics estimates that in 1996 the pregnancy rate was 98.7 per 1,000 women aged fifteen through nineteen years, for a total of approximately 893,000 pregnancies. In that year, just over half (55%) of these pregnancies resulted in a live birth, with 30 percent ending in induced abortion, and 15 percent in fetal loss.
Pregnancy and birth rates among teenagers have varied considerably over time. Figure 1 depicts rates of birth among women aged fifteen through nineteen years from 1940 to 1999. Teen birth rates were at their highest from the late 1940s through the early 1960s, mirroring the elevated rates seen among all women of childbearing age during this time period, commonly referred to as the "baby boom." More recently, birth rates showed a relatively modest increase in the late 1980s and early 1990s, and declined steadily thereafter. Data for 1999 indicated that the teenage birth rate in that year fell to a record low of 49.6 births per 1,000.
Teen births tend to be concentrated in later adolescence, with two-thirds of the total births in 1999 occurring to women eighteen or nineteen years of age. Birth rates also vary among teens by race and ethnicity. Non-Hispanic white teenagers have historically had much lower birth rates than other groups. African-American teenagers ranked highest of any group until 1994, after which marked declines led their rates to track somewhat below those of Hispanic teens.
Teenage Pregnancy and Later Outcomes
Becoming a mother as a teenager is associated with higher risk for a number of poor outcomes. Teen mothers are less likely to finish high school, less successful in the job market, less likely to marry, and more likely to rely on public assistance than women who have children after their teen years. In addition, children of teen mothers generally do not fare as well as other children. They tend to score less optimally on assessments of cognitive development and academic achievement, and also tend to exhibit more problem behaviors than other children.
Although teen pregnancy is associated with this myriad of unfavorable outcomes, it has become widely acknowledged that such outcomes should not simply be interpreted as being caused by early childbearing itself. This is because teen births do not occur randomly among women in the population, but rather are experienced by women who themselves are much more likely to have come from disadvantaged backgrounds. Teenage mothers are up to twice as likely as other women, for example, to have grown up in single-parent families. Many teen mothers have spent much of their own childhood in poverty, often living in impoverished neighborhoods characterized by poor schools, inferior public services, and limited career options. Since people who come from disadvantaged backgrounds are generally at higher risk for poorer outcomes, it is very difficult to sort out whether the long-term difficulties experienced by teen mothers and their children are due to early childbearing, or are the result of the mothers' preexisting economic and social disadvantages.
During the 1990s, researchers used innovative methods to try to better understand the actual consequences of teen childbearing. Arline Geronimus and her colleagues studied pairs of sisters in their late twenties and thirties in which one of the pair had a birth while a teenager and the other did not. Since both sisters were raised in the same conditions, this strategy provided a way to control for many aspects of background disadvantage when examining ways that outcomes differed for the teen and nonteen mothers. Using data from several nationally representative surveys, they found that the long-term "costs" of teen childbearing were lower than previously thought. Results based on one of the surveys indicated that future incomes and employment status were not significantly different among teen and older mothers. Similar analyses done by Geronimus and others (and replicated by Saul Hoffman and associates using data from another survey) did show somewhat lower incomes and poorer economic status among teen mothers when compared to their sisters who were not teen mothers. Although findings varied in different surveys, all of these studies consistently demonstrated that previous research, which did not account for background disadvantage, tended to overstate the negative consequences of teen child-bearing.
More recently, Joseph Hotz and colleagues compared mothers who gave birth as teenagers, with women who became pregnant at the same age but suffered miscarriages and subsequently delayed child-bearing for at least three or four years. Their results indicated that, on average, those who gave birth actually had significantly higher incomes later on than women who had delayed childbearing. In this study there was no difference among the groups of mothers in the likelihood of obtaining a high-school level education, although teen mothers were more likely to obtain a GED than a high school diploma. Teen mothers also tended to have more births by age thirty than the other mothers, and had spent a greater proportion of this time interval unmarried.
Studies have also examined the consequences of teen motherhood for children. For example, Kristin Moore and associates compared outcomes among children of teen and nonteen mothers, using a set of standard statistical controls in their analyses for maternal background factors and other characteristics. They found that children of teen mothers experienced a significantly lower quality home environment, and children born to teens aged seventeen or younger were at a significant disadvantage with respect to cognitive development and academic achievement. Using their sister-pair strategy as a more comprehensive way to control mothers' background disadvantage, Geronimus and colleagues found that children of teen mothers actually did better than children of nonteen mothers on several cognitive and achievement tests; and on other tests, no significant differences among the children were observed.
In sum, research findings highlight the important and previously underemphasized role that disadvantaged conditions prior to pregnancy play in the poor outcomes seen among teen mothers and their children. There is general consensus that earlier studies exaggerated the consequences of teen child-bearing because they failed to effectively take these background factors into account. The true nature and the extent of the outcomes caused by teen childbearing remain controversial, largely due to the fact that the data currently available with which to study them have significant limitations. More definitive answers will require the development of larger and more detailed surveys that follow childbearing women and their children over longer periods of time, as well as improved research methods for quantifying causal effects with increased certainty.
Public Policy and Teenage Pregnancy
Just as there is a lack of consensus about the consequences of teenage pregnancy, the optimal focus for public policy and intervention is also in dispute. Some experts reason that because the disadvantaged circumstances in which many women grow up are a predominant factor impacting teen birth rates, policies and programs would be most effectively directed at ameliorating that disadvantage and developing positive life options for young women. Others, however, maintain that in the absence of conclusive research findings to the contrary, targeted interventions such as the National Campaign to Prevent Teen Pregnancy initiated in 1996 have potential benefits and should continue to be pursued.
It is clear that teenage pregnancy fell steadily over the 1990s in the United States, with reductions seen for each of the three pregnancy outcomes (live births, induced abortions, and fetal losses). The National Center for Health Statistics noted several concurrent trends related to teen pregnancy rates over this period. First, rates of sexual activity among teenagers appear to have stabilized and perhaps declined, as measured by teens' responses in several national surveys. In addition, increases have been reported in condom use and in the availability and adoption of other effective birth control methods including injectable and implantable contraceptives. These behavioral trends may well have been influenced by educational and contraceptive-related intervention programs; however, it is also important to note that they occurred during a period of remarkable, sustained economic expansion. This expansion increased the opportunities available to teenagers, making higher educational and occupational goals more desirable and attainable and in the process providing a powerful impetus for behavior change.
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