Teenage Pregnancy: Impact on Adolescent Development

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STATEMENT OF PURPOSE TIIE GROUP FOR THE ADVANCE.\.IENT OF PSYCHIATRY has a membership of approximately 300 psychiatrists, most of whom are organized in the form of a number of working f committees. These committees direct their ef orts toward the study of various aspects of psychiatry and the application of this knowledge to the fields of mental health and human relations.

Collaboration with specialists in other disciplines has been and is one of C-AP's working principles. Since the formation of GAP in 1946 its members have worked closely with such other specialists as anthropologists, biologists, economists, statisticians, educators, lawyers, nurses, psychologists, soci­ ologists, social workers, and experts in mass communication, philosophy, and semantics. GAP envisages a continuing pro­ gram of work according to the following aims:

Library of Congress Cataloging-in-Publication Data

Crise.' of adolesceurt'. tc-c,rnge prcg11ant..y.

(Report/Group for the /\dYanccu1c111 or l's1chia1n·: no. 118) !11clucles liibliographics and index.

I. Pregnancy, Adolesccnt-P.s1·cholugiral aspens. '.!. Adolescc:111 parent.s-�lcntal health. 3. ,\dolcscc11n:­ Pli)'siulogical aspects. 4. Pn::gJia11<.y. Adolescent­ Economic aspect.,. I. Croup ro1 the A,hanccment o! l's)chiatrr. Commiuee on t\dolcsce11ce. II. Series: Report (Croup for the ,\,.h-ancc11tc111 or l's1<: hiatn"): no. 118. [D:sJI.M: I. Adolescent Ps)·chulog,·. :Z. Human Developmt:nl. 3. Pregnnnc, in Adolc-scnKc. Wl RF.20!/BR no. I Ill ! \I'S 41i2 UJ:.1:!/ RC32I.C7 no. 118 hlti.89 s [l:'i:i.:i''\'.l/ Hu-'.1:lO--l !RJ:i07.A34/ 1sn:--. o-871j::10-12G-9 JSgl\ U-871530-427-7 (soft) 1

1. To collect and appraise significant data in the fields of psychiatry, mental health, and human relations; 2. To reevaluate old concepts and to develop and test new ones; g_ To apply the knowledge thus obtained for· the pro­ motion of mental health and good human relations.

Copyright© 1986 by the Grnup for the AdYanccment of P�ychiatry P11/Jli.1hed /Jy BRC;\":\ER/�!AZEL, INC. 19 l:nion Square WesL :\cw York, :-(cw York 10003 All

rights

rcscn·ed. :\o part or this book n1a,· he reproduced hy :111y pcrrnisslon of the ('opyrigh1 O\\'Ilt't.

soever withuu1 l11c wri11en

�IA:\UFACTURED 1:\J

II IL

process

l :\ITED ST.-\TES Of :\\!ERICA 1

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GAP is an independent group, and its reports represent. the composite findings and opinions of its members only, guided by its many consultants.

TEENAGE PREGNA1'CY: Irv!PACT O'\ ADOLESCENT DEVELOP­ MENT was formulated by the Committee on Adolescence. The members of this commiuce are listed on the next page. The follm-ving pages list the members of the other GAP commit.­ tees, as well as additional membership categories and current and past officers of GAP. V

viii

Teenage Pregnancy: Impact on Adolescent Development

COMMfl I l.E ON tvh·..,:TAL H E�\L0I H SF.R\.ICJ:::-. c:corge F. Wilson, Helle Mead, I\.J, Chairpc1 so11 Allan Reigel. Tutson . .'\riz.

Merrill T. Eaton, Omaha. l\eur.

John M. Hamilton, E\;iltimorc, :¼d.

W. Walter M,nninger. Topeka, Kans.

Jose :\fa.na �antiago, Tutson, A112.

Herd R. Spiro, Milwaukee, Wis. William I,. Wehb,Jr., Manford. Conn.

Jack A. Wolford, l'it1sburgh, Pa. • Co'-t:-..trn t.1. o:-- PK.1.vt.NTtn•: "1'!>\ GI 1 1 -�.-nn Steplit"n Fleck, !\c,�· Haven, Conn., Chairperson Viola W. B,rnard. l\ew York, i\ Y. St;mley I. Greenspan, flethcscb. Md. William 1·1. Hctrneckcr, Philadelphia. Pa. Richard, G. .Ylorrill. Bn�lon. >iass.

Harris ll. Pl'rk, 'lc11· Rochelle. I\.\'.

Anne Mdric-: \Volf, Phildtk·lphia, Pit. C:<nn11 J I H:. OK PS\'CHl ·\TR\-" -"�I) ·1 1n. CO\IMLi:--l'IT, John /\. Taluotl, l\',•w \'ork, I\.\'.

Chairpcrsm1 C. Knight Aldrich, Charln11e"illc, \.'a.

H. Rich,ml Lunb, Los Angeles, C1lif.

Kenneth Minkoff, Som<-nilk·, M.:13s.

John C. l\e111iah. Hanover. K.H. Rel>l"U.a L Poller. Tucson. Ari, Alex,mde1 S. Roga" ,k,, Los Angeles, Calif.

John J Schwab, l.ouisvillc, Ky. Charles B. Wilkimon, Kansas City, Mo. C<>��tlYl'i.t-· O'l P?.\ <:HJA IRY Af\.0 LA\\'

Jona, R. Rappcport. Bahimor(', Md.,

Chairperson Park E. OicLZ. Charluuesvillc, \'a.

John Donnelly. I ldrtforcl, Conn.

Cad P. Malmquist, :vrinncaprJ!is. �!inn.

Herbert C. �lodliu. Topeka. Kans.

Phillip . J . Kcsnit:k. Cle,·eland, Ohio Loren J. RoLh, l'itl!, burgh, Pa, . Josc-ph Sc1ttcn, San Francis< :o, Calil'. \.\'illiam D Weit,.el, Lexington. K\-·.

Htm.ird \". Zonana. New H.n·cn, Conn.

CoM.,11 rru: o:-.. P!)\'<...IIIA'ft-t.\· ANI> Rn H.ao� Albert . J. Luhin, Woodside, Calif..

Chairpcr.-.on

<iidnt"� Fun.t. Bronx, ).; . \'.

Richard C. Lewis, l\ew Haven. Conn. f.arl A. Loomis.Jr., Augusta. Ga. Monirne, Oliirow, Bronx, �.Y. Sally K. Sel'erino, \\'hite Plain,, N.\'.

Clvrk K Snyder, PSf, Calif. �lichacl H.. Zalcs, Gn.·rrrn ich. Conn.

CoM.\111"1'1.::l-. 0:\ PsVCIIII\TRY l'-t 1Nt)l� l'R\' Barrie S. Grciff, CJ.ml>ridge. Mass ..

Chairper,on Pet""r L. liriH, Philadd J>hia, Pa. nuanc Q. Hagen. St. Louis, Mo. R. Edw,trd Huff111an, A•hc1•ilk. :-,;.c.

David t:. �(oniso11. Palatine-. Ill. David 13. Robbins, Chappa,,ua, :-.:.Y. Jay B. Rohrlich, !\ew York, :-J.Y. Clarence ). Rowe. St. Paul. Mi11n.

Jeffrey 1.. Speller, AlexJ.11dna. \ ,\.

John W:ikclicld, Saratoga, Calif.

COM.\IITI Ft-: 0� P!-tYC:HOl'A I HOI t >C\ na,·id A. Adler. Bostnn, Mass..

Cl1airperson Jeffre) Beila11t. San A11sel1110, c;;tlil.

Doyle l. (';ir.son, D�tlla.�, Tex. Robe11 I·:. Drake. l lanm-c1 , 1'.H. Ho",ml H. Goldman, Rm k1·ille. Mel. Johanna A. llolfma11, Rict,mond. \'a.

Richard F.. Renn<·kc,, 1 .os Angel,·s, Cali I.

C<>MM I tT• r ON PL'BI.IC I:.occ.,Tto"-' Robert A. Solow, fkvcrly Hills, Calif., Ch,1i1 pcrsou Susdn J. l\lumcnthal, Rockl'illc, �Id. Rohcrtj. Campbell. :-;,-,· York. I\.\'.

Keith H .Johansen, ll:illas. T,·,.

Ste,en L Kal7. !\c" York. I\.Y. �orm::tn L. l .ol1X. ScHc:r�vilk·, P,1.

HarvC}' L. Ruben, l\t"\\' HdYCn, Conn.

Kenneth !':. Vog:tsbcrgcr. S;,m Antonio, Tex.

Co'\011 n 1:.1-: oN RrslAN.CH R.obrn Ca1n.ro, J\:ew Yorl. :\'.Y., Cha1rpe-1son Kt�nneth 7. All"hule-1, Dalla:-., l'ex. ,latk A. Grcbb. !\cw \'ork, I\ .\'. ]0l111 1 1 . Greist, !lladis<>n, Wisc.

Jerry M. lA·wis. l)all.t�. T<'�-

GAP Comm ittees

ix

and Membership

Morri.s A. l .ipton, Chapel Hill, ·:-; .C. J<>hn G I. ooncy, Dallas, Tex. Zebulon Ta.intoL Orangeburg, �. \'.

COf\·1:\H i-J I· t ON SOCIAL LSSL't:S I,m E. Alger, �e,\· York, l\".Y., Ctl�1irperson \Villiam R. Beardskc 1 Boston, �'la!is.

Paul J Fi11k, Phihtdelphia, Pa. Henry .J . Gault. Highland P,1rk, Ill. .J udith I l. (;old, Halifax, J\io,a Scot.ia Ro,kric Gorney, Los Angc:lc,, Calil'.

Manha J. Kirl..patrick, Los A11geles. Cali!.

Perry Ottc:nbcrg, Phila<lrlphia1 l1a.

K<>nclo11 \\I'. Smith, Piermont. N.Y. COM.\11 1 l l-.:l:. o:-.. TH►_ltr\J1l:TTIC C.\Kl-. �lilton Krantcr, Cincinnati, Ohio, ('.hairpcrc..on Bernard Bancller, Ca111hridge, :vlass.

Thomas �.. Curti,, Chapel l l ill, N.C. Robert \\.'. Gilison, Tnwso11, �·td.

Donald \V. Harnmcr,lcy. Washing1nn, D.C. William B. Hunter. 111, Albuquerque. N.\1.

Roberto t... Jimenez, .San Antonio, Tex. Meh·i11 S,1bshin, \·V�shington. D.C. T

C.OM�-IlT .E.l: ON TtitJ{.-\l''t Allan D. Roscnblau, I.a Jolla, Cali!..

Chairpcnon Henry \-V. Rn.1sin, Tuu;on, Ariz. f.uge11e B. Feigelson. llrooklyn, KY. Robert Michels, :-Jew Yo,·k, l\'.Y. Andrew P. )..i()rrison, Cambridge, \lass.

Wi1Ji,m1 C. Offrnkrantz, Millfaukee. Wis. C<>:---TM.Wl..l l�C M1:.:-.1Ut::RS John E. Adams, Gaim.:,,ilk, Fl. Carlos C. Alden, .1 r., Buffalo. I\.\'.

Mary Ann 13. Bant1Sis, �lorriwillc. Pa. Eric. i\. Baum, Akron, Ohio Spene.er B.-1rles, l louston, Tex .

A;iron T. lle<:k. \V\'nncwood, Pa. C. Chri<.;tian l.kds,' New York. i\·.Y. F.lissa .P. lk11cdck, Ann Arbor·, Mich.

Sidney Berman, Washington, D.C. \\'ilfn·d Rloomb<'rg. Carnhridgc. �fass.

H. Kei1h 1 1 . l\rodie, Durham, �.C. Charles T\i. Br}'ant. San Fr;1nriscu, Calif.

Ewald W. Busse, Durham, l\'.C. Robert N. Butler, Ne,\: York, !\.Y. Eugene M. Caffcv.Jr., llowic. Md. Paul C:hodofl, W,1shington, D.C. lan L.\\-'. Clancey, Ontario, c�mada San(ord J. Coh<>n, Roston, �lass.

James S. faton, .Jr .. Washington, V.C. Lloyd C. Elam, l\'a.shvillc, Tenn.

Stanley H. Eldred, Belmont, Mass. .Joseph T. English, l\cw York, N.Y. Louis C. English, Pomona, '11 Y Archie R. Folcv, New York, !\.Y. Daniel X. Freedman, Chicago, Ill. Alexander c;ralni<..:k, .Port Chester. l\.Y. Milttm Greenblatt, Sepuhecla. Calif.

Lawrence F. Crccnlcigh, Los Angeles, Calif.

F.rnest M. Gruenl>t'.rg, Bechcsda, �,td.

Jon .E.. Gudcman, Lexington. f\·1ass.

Se)'mour L. Halleck, Chapel Hill, :-,;,c.

Stanley Hammons, Lexington, K).

J. (AJt.:cr I lirschbcrg, Topeka, Kaus.

Jay Katz, �ew lJa\'en, Conn.

New Orleans, La. .James A. Knight, .

Othi.lda l\·1 Krug, Cinciuuati. Ohio Alan I. Levenson, Tur.c;on, Ariz.

Ruth W. Lidz, Woodbridge, Conn.

Orlando 8. Lighth.>ol. Boston, Md.".,· Reginald S. Loune, Chevy Chase, Md. John A. MacLeod, Cincinnati, Ohio Leo Mado"·· l'hiladclphia, Pa. Charles A. �.Jalone, Clel'e)and, Ohio Sidney C. M:1rgnlin. Denver. Colo.

Peler A. M.1r1in, Bloomrickl Hilb., l\•I ich.

Ake MaW!SOll, ).;"ew Yorl. N.Y. :\Ian A. McLean, \Vcstpon. Co1111. l)a,·id \lcnclcll, Houston, Tex. Roy \V. Menninger, Topeka, Kans.

Ma,) I:.. \tcrcer, Nya<:k, !\.Y. Joseph fJ. Koshpitz, Washington. n.( ..

Charle, P. O'llrien, Ph;Jadclphis, Pa. Rcrnanl I .. Pacella, t\"cw York, �-Y. Herbert 1',,rdcs. Sew York, r-.:.Y.

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ȵ΁°¸‫ؾآ‬ƞ ‫ ؾ‬ɨʾ1њ ŀŁϡ ‫׊‬ӾłŃē‫ؾ‬ZʿѺ ̊ģå'‫ؾ‬ɩ΂‫ؾ ؚ‬ Ƈ°‫ؾ ̩أ‬ɪ΃ҞԽ ζ‫׋‬ӿҼ&‫ ؾ‬ȶ Ш̖͎η4ԾϼЩˀæ‫? ؾ‬ˁ ‫ؾ‬ H P AUVZ‫ ؾغ ظ‬-B6GQC; Z ! X"IRD< Z J#, Z ǯԱ~‫ؾ‬ȷ ‫ؾ‬ɫ‫׮‬Կ 8ç‫ؾ‬en̪<˂ҟ ҽ¼Ԁ ‫ؾ‬Ɵ˃Ѧ ϑį‫ؾ‬ Ŧǰ: "‫ؾ‬ŵ ‫ ؾ‬ɬ‫ׯ‬T‫ش‬Ҿ΄Ւ ə˄¢‫ ؾ‬njՓoҿv ֑̫ԁ‫ؾؼ‬Ơ˅ѧЪϒM‫ؾ‬ ʁp Քz ‫ؾ‬ɭ ‫ ؾ‬ɹˆ‫װ‬ϢϽˇӀĔDZձĤC‫ ؾ‬ȸԂµÀ¨Ѩˈ‫ؾ‬ɺˉ ѻ΅‫ؤ‬%‫ؾ‬ ơˊѩЫυĕ‫ؾ‬ Ɇԃ̟θ »‫ؾ‬ɚ ‫ ؾ‬fˋѼ3 ղĊ¼ΆЬӁE‫ ؾ‬ɛˌ£‫ ؾ‬Ǒ³ˍ8̬Э̭֒Ԅ ‫ؾ‬Ƣ̎0S Юψ ‫ؾ‬ Ŷӂ͏Օ·؋‫ؾ‬ɜ ‫ؾ‬ʂˎѽɦȬӃè‫ؾ‬ŷӄӅ‫ ؾ‬Ÿ±̗ ±é‫ؾ‬ȕЯ̮Ͼ ‫ؾ‬ ƈՖ‫خ‬pӆ‫ؾ׌‬Áɻǩ ‫ ؾ‬ʃΈŬҎϣΉê‫ ؾ‬ʄˏ֓ ! ‫׍‬ԅӇD‫ؾ‬ωѾJƣK‫ؾ‬ ǹԆ=ΊՀ ‫ؾ‬Š ‫ؾ‬ʅ ΋ι4،՗аϤϿ‫׎‬ë‫ؾ‬ǽ|ӈ‫׏‬ϊы͐x ‫ؾ‬Ƥː3бϋ ‫ؾ‬ bԇuκճ‫ؾכ‬ȋ ‫ؾ‬ʆ. ѿ iҠ֔ ‫^ ؾ‬Ԉ>֕‫"©א‬ì‫ؾ‬ɮ ŭ ‫ؾ‬ ȹˑ‫ؾ ױ‬ɯ‫إ‬Ҁλ՘‫ؾ‬ʇв ֖ԉӉE‫ ؾ‬WΌ‫ב‬Ѐ΍֗͑˒ ‫ؾ‬ʘĻ͒ ‫ؾ‬ ɝЁΎ‫ئ؍ג‬ӊ‫ ؾ‬ȖQ‫ ؾ‬ʈԲԳ͓֘í‫ ؾ‬ȇԊ֙‫ؾ‬Ź¤ϥΏ ΐ֚Ė‫ ؾ‬ƥ˓ҁьόĥ‫ؾ‬ $=SZ Z .78%K9 > Z &L1*4'Y Z 3/+ Z ǡ֛ ˔μ ‫ ؾ‬ʖ؎ эӋϦ ‫ ؾ‬ȺЂг ˕͔ν҂ՁЃ ˖F‫ ؾ‬Ȼ˗‫ؾ‬

Ȟ ̵Г˽ 5‫ؾ‬Ɉ ‫ ؾ‬ʗ˾ѱΧ‫ؾؽ‬ LJͤϭΨؕԤԥ ‫ؾ‬ǁ ؆Ω‫ؾ‬ Ǘի̼ċΪ7‫̺ ؖ‬Д%‫ؾ‬ƳԦӦ! ‫ؾ‬ijŗšÌSҊȭ‫ؾ‬

01;< ȟ ‫ ؾ‬9 3< ' 2$ :,< 6% 4/!7 &< ɁOȫĠ‫ ؾ‬Ƒԧ‫ ؾ؛‬ŎśĴŜŢť‫ؾ‬ ǂk ҋ˿ֱĆ‫ؾ‬ɵΫ‫ؾ ؜‬ŝŕŏŐп‫ؾ‬ ɣσĮ̏ѲҤ Ñ‫ؾط‬ Ɓ Ҍ̀ӧ‫ ؾ‬ҔҕyрϮ̻ ‫ؾ‬ œĵ‫ؾ‬ƴćŇňʼnļсŊŋĶ‫ ؾ‬Ljֲ­́ĽтԨ3‫ؾ‬ ɶ‫׺‬լ‫ֳؾ‬ԩ Ĉ‫ ؾ‬Ƃ¸у‫ر‬ġ‫ ؾ‬ţŖ‫ؾ‬Ş‫ؾ‬ǧ‫ؾ‬Ř‫ؾ‬

Y ̂չ άִ‫ؾ‬ƒ ‫ ؾ‬ʎё ў Өֵ«7‫ؾ‬ řķĸ‫]ؾ‬P‫ؾ‬őŒөͥ‫ؾ‬ɤ խ}έ‫ؾט‬ ȁ̃¥ֶ̌¹‫ؾ‬Ƶф‫ ؾ&حי‬ȠԪ ‫ؾ‬ŚŔľĹŤ‫ؾ‬

ƹī‫ ؾ‬Ǿӌд,Є‫ؾד‬ź4͕ՙ ̯Ѕî‫ؾ‬ƦІ˘՚Ѫԋ‫҃ ؂֜ ל‬1Αï‫ ؾ‬ɼ˙ ‫ؾ‬ ƉΒռq՛͖‫ ؾ‬Ɗ˚Ӎ͗ю ð‫ؾ‬Ƨ˛ҡ̘՜е͘ϧñ‫ص‬ė‫ ؾ‬ȗ˜ּֽH‫ؾ‬ ʉ˝҄‫ם‬Γ՝‫ؾ‬Dž ‫ؾ‬Xq´¾ ӎò‫ؾ‬Ǚ˞ӏĪ ̍ӐwG‫ ؾ‬ɽ‫ؾ מ‬ Ǣ‫ؾ ˟؃‬Ʒ ‫ ؾ‬ƋΔ® ӑ ‫ ؾ‬ƨԌ²m2‫ ؾ‬Ïūˠ̙ Ε֝Ę‫ ؾ‬Ǐ ˡ ‫ؾ‬ ɾж© ˢ‫ ؾ‬ʊ ‫ ؾ‬ƌΖս)³ ó‫ ؾ‬ȤΗ؏‫ؾ‬ʒª՞ћ ‫ ؾ‬ȥ ʓ ‫ؾ‬ Ș‫ײ‬ǻɷˣ‫ ؾا‬ƍӒؐΘ! ‫ ؾ‬ƩЇ+؄‫ؾب‬Y ˤ֞Ιô‫ؾ ͙` ؾ‬

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8

Teenage Pregnancy: Impact on Adolescent Development

more mature contemplation. Adolescents develop the ability to consider possibilities; they can explore potential conse­ quences without having to commit. thought. to action and experience the results; they can plan a future. Realistic self­ assessment and appropriate goals for future work replace unrealistic expectations. Moral values and belief systems strengthen during this period although challenged on many fronts. With success, the completion of these tasks leads to the formation of a stable adolescent and adult identity.

These tasks of adolescence are not easily accomplished given the timing of the biological, psychodynamic, psycho­ social, and cognitive development of the adolescent. Biolog­ ical puberty heralds the onset of adolescence, six months to two years earlier in girls than in boys. Physiological and an­ atomical changes continue well into the middle or late teens.

New sensation·s, drives, and capabilities require considerable time to be integrated and consolidated into the adolescent's sense of self.

In both sexes genital stimulation can be recognized at an early age. Masturbation occurs in infants and children as a normal means of pleasure and self-solace. In adolescence masturbation provides a way of expressing and managing powerful sexual urges. It can be viewed as a method of ex­ perimenting with one's own physiological and psychological capacities.

The midadolescent girl is in a vulnerable position regard­ ing her self-concept and societal roles and will often expe­ rience difficulty coping with her rapid physical changes. Her attitude toward menarche and sex in general is often influ­ enced by her mother's attitude. If the mother's feminine self­ image is unsatisfactory, she may convey negative feelings about female attributes and female bodies.

Masturbation is a central issue in the development of girls and boys. Girls can frequently deny that the pleasurable sen­ sation derived from pressure on the inner thigh is a mas­ turbatory act, but boys, with their obvious erections, cannot.

Adolescent Development and Sexuality

9

Guilt feelings, in relation to moral behavior and incestuous fantasies, can act as powerful deterrents to otherwise natural urges.

For boys and girls masturbation may become a significant developmental activity at puberty and a method whereby the experience of sexual excitement is allied with fantasies about sexual involvement. Pubertal masturbation is a way station on the road to adult sexuality.

Through masturbation a boy, particularly, may learn to master a seemingly uncontrollable body. Erections are more frequent as puberty proceeds and arouse awareness of the feeling that a part of the body is, and his feelings are, out of control. The masturbatory act helps to control tumescence and detumescence. In addition, through masturbation the boy can learn to separate aggressive and sexual impulses; a primitive mixture of aggression and sexual fantasies can be­ come clarified and reworked.

In middle-class culture, masturbation continues usually into adulthood by which time occasional intercourse or pe­ riods of regular sexual involvement with another person have become the preferable activity. The sexuality of adolescents is initially more experimental than loving. Heterosexual ex­ ploration in midadolescence has less the function of estab­ lishing an intimate tie than of helping LO explore and understand new sensations (Kestenbaum, 1979). It may also be conducted in response to peer pressure and from a sense of competition. It is a major problem that more adolescents are beginning sexual intercourse prematurely.

Susan was a 14-year-old honor student from a "liberated" home. Her mother assumed that she was a responsible girl, gave her a talk about "the facts oflife" after her first menstrual period, and told her she could now handle her own private f life. But one ef ect on Susan of her parents' permissive arti­ rude had been that they had not helped her to learn which qualities in herself she could be proud of and which were less admirable. Without an internalized sense of self-esteem, Su-

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Context and Meaning of Pregnancy: Teenage Mothers

17

also reported that one of the major reasons given by girls for failure to use protection was not that they did not know about contraceptives, but that they thought they could not become pregnant because of their age, the point in their menstrual cycle, or the infrequency of intercourse. Cobliner (I 974) found that some pregnant girls had incorrect information about the efficacy or danger of certain contraceptive tech­ niques; others had accurate knowledge but did not practice what they knew. Rogel et al. ( 1980) found great fear of the pill among black adolescents in Chicago, while other birth control methods were rarely thought about. The timing and source of information also can be a major factor.

While not concerned specifically with contraceptive infor­ mation, Goldfarb et al. ( 1977) developed a predictive profile of the teenage indigent girl at highest risk for pregnancy.

They found that girls most likely to become pregnant were from large families, received their sex education late and from other adolescents, and although of normal intelligence performed poorly academically or disrupted their education.

The Alan Guttmacher Institute ( 1985) study of teenage pregnancy, abortion, and birth rates in developed countries showed that the rate of pregnancy per year in the United States was 96 per 1,000 girls 15 to 19 years old compared with 14 in the Netherlands, 35 in Sweden, 43 in France, 44 in Canada, and 45 in England and Wales. Sexual activity rates of the girls were approximately the same among these coun­ tries, but teenagers in the United States were less likely to use contraception. It was noted that those who did were less likely to use the pill, which is considered to be the most effective method.

Giving information to adolescent girls and boys does not mean that they will acquire usable knowledge. Those teaching birth control may not be thoroughly trained or may be uneasy about imparting full information to teenagers. Dialogue with teenagers sufficient to discover and correct confusions and misunderstandings must be aimed at making sure that the

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Health and Socioeconomic Consequences

47

graduated. The effect of teenage childbearing on college graduation is even greater; by age 29, women who delayed motherhood until their twenties were four to five times as likely to have completed college.

Carla was 14 years old when she was firsl seen for psychialric evaluarion; ht>r ;1cademic performance had dropped mark­ edly and she was five months pregnant. Carla's father had abandoner! the family when she was an infant, and she now lived wilh her mother, two older siblings. and her sisler's out­ of�wedlock infant daug-hter. The family was dependent on welfare. Carla's emotionally clepri,·ed and unsupervised early childhood helped her to find school an exciring adventure.

She did well until age 1 � when her sister's baby was burn, when she was pressed frequently into 1he role of caretaker and began to miss a great deal of school. She herself soon became pregnant after a brid encounter with a teenage neigh­ bor. Carla <lid not return to the clinic for two years. At the second visit she was 16, the molher of a year-old son and the chief caretaker of a lhree-year-old niece. She had dropped out of school and felt hopeless and depressed.

Chilman ( 1980) suggested from her study of the existing research that adolescent parenthood was only one factor in maternal school dropout. She wrote that teenage mothers may have tended to <lo poorly in school before pregnancy occurred; early marriage rathc.:r than pregnancy was more closely associated with dropping out of school. Nevertheless, the effecl of early childbearing on educational opportunity is not simply the result of low aptitude, poverty, or lack of interest in learning. A national study that followed up sam­ ples of young people matched for race, socioeconomic status, academic aptitude, achievement, and educational aspirations at age 15, by Card and Wise (1978), round a disparity in educational accomplishments when this sample was reinter­ viewed at age 29: mothers who had given birth before Lhey were 18 were only half as likely to have graduated from high school as were those who postponed childbearing until after they turned 20. Further evidence that teenage pregnancy is

48

Teenage Pregnancy: Impact on Adolescent Development

a disruptive influence in itself can be inferred from data showing that in terms of educational and occupational at­ tainment, socioeconomically advantaged young mothers seemed to suffer greater disruption following a teenage birth compared to those who were not advantaged (Card, 1977).

For young fathers in the matched samples, the effect was less dramatic but still substantial. Those who became fathers before age 18 were less likely Lo have graduated from high school and college. One possible compensation for those with­ out personal advanced educational goals is that those who entered the work force early as a result of premature high­ school dropout ·were more likely to accrue seniority in their jobs at an earlier age than their peers who remained in school (Card, 1977).

Some studies indicate that children of teenage parents may suffer a higher incidence of cognitive and educational deficits (Baldwin & Cain, 1980). Dryfoos and Belmont ( 1978), after controlling for differences in socioeconomic status, race, and other variables that are correlated with both early mother­ hood and low cognitive scores, found a small but consistent linear relationship bet.ween lower maternal age and lower intellectual achievement by the children. The follow-up of the Furstenberg (1976) study of a small sample revealed that children of adolescent mothers had less wgnitive develop­ ment than did children of older mothers. Their level of at­ tainment was related strongly to their socioeconomic background, again a legacy of the excessive youth of their mothers (parents).

As with child abuse, efforts have been made regarding cognitive stalus co determine the factor of teenage parent­ hood as a determinant of disorders. Card (1978) found, after controlling for parental variables in race, socioeconomic sta­ tus, and maternal intelligence in children at the high-school level, some relationship between intellectual achievement and maternal age, particularly if the mother was under age 15.

Children of adole.�c:eut parents scored lower than their class-

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Interventions and Recommendations

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including referral to licensed adoption agencies in the community if the eligible grant recipient is not a licensed adoption agency.

Primary and preventive health services including prenatal and postnatal care.

Nutrition information and counseling.

Referral for screening and treatment of venereal disease.

Referral for appropriate pediatric care.

Educational services relating to family life and prob­ lCins associated with adolescent premarital sexual relations.

Appropriate educ.at ional a11c.l vocational services and referral to such services.

Referral to licensed residential care of maternity home services.

Mental health services and referral to mental health services and to other appropriate physical health servICes. Child care sufficient to enable the adolescent parent to continue educatiori or to enter into employment.

Consumer education and homemaking.

Counseling for the immediate and extended family members of the eligible person.

Transportation.

Outreach services to families of adolescents to dis­ courage sexual relations among unemancipated mmors.

Family-planning services.

Intervention should begin as early as possible during the pregnancy so that optimal health care for the mother and fetus as well as psychological preparedness for the birth can occur. The need for the adolescent mother to continue her own development hy means of school and job training must be addressed, as well as planning for the best available care for the infant.

66

Teenage Pregnancy: Impact on Adolescent Development

Risk factors in each adolescent family must be determined.

At-risk implies that the mother may be unable to provide the minimal care for her infant that is necessary for adequate development to occur. The adolescent mother is often ig­ noranL of child care techniques, may have emotional prob­ lems, and may be anxious and overstressed by parcmhood.

The intervention during the birth process is of particular importance. The young mother should have the support of a familiar team member with whom she has already had several meetings. Many of the iufants born to adolescent mothers arc of low birth weight and need to remain in nur­ series for days or weeks. The team member may help the mother to 0Yercome the effects of sensory deprivation fre­ quently experienced by the isolated premature infant and help in a bonding process, which might otherwise be dis­ turbed.

The post.delivery services provided by a teenage program can best be utilized when the introduction to the program has occurred before birth. The role of the program is to help young mothers learn parenting skills as well as meet with other young mothers in a safe and protected environment.

In such a center they can share experiences and discuss per­ sonal and parenting issues. Many inner-city adolescent moth­ ers have serious social and psychological problems; most of them do not use the conventional social and psychiatric serv­ ices available in a community. The program serves as a way of helping young mothers to improve their own situation within their nuclear family and to outline personal goals. The children's needs are served when the young mother gains firsthand knowledge of lhe principles of child-development and learns how to help her child achieve social and cognitive skills in the day care setting provided by the program.

One group of pregnant teenage girls that undoubtedly should come to the attention of psychiatrists consists of in­ dividuals with severe psychiatric disorder who have been hospitalized. These girls, their families, the fathers of their

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78

INDEX

development.al crisis and, xviii-xi, i111paircd clC'vdopmental tash of, 33-34 sexual development, I!-') sexually active. 3. Y-10, 26-27. :iY Adoptio,;, :,, 3i, 58, 6:�-6:,, i3 Aggression, 9 Aid to Families with lkpendent Children (A FllC). :, I i\lan (;unmachcr Institute, 3, 17, 46, 50, 61 Alcohol abuse, 4 Anaditic bondage, 30 Anemia, 44 Anxiety. 18. 34 abortion and, 36 child ah1m· and. -lti Apathy. 18- lY Autonomv. 7, JI. 20, 26, se, aLm Sepa;ationiindi,·iduation in healthy adolescent girls, 35-36

Abernethy, C. L., 19, fiO Abernethy. V.. I 9, 60 Abortion. :i, 35-38, .�8 c:osr.sol,:il counseling and, 62-63. 73 father's influence on, 20 hC'alth risk and. ·l·J.--45 as the lcasl disabling clwice, 70 lower marriage ratt's and, 40 pan:11ts' consent a11d, fi I Abt Associates, -� I ,\cting-nnt bcha,·ior, I�. '.l I Adolescent boys fantasies abciuL pregnanq, 12 rnasculinitv and, 29-30 sexually a�tiYe, 26-27 Adolescent fathers, 2,,-:i I education, 48 groups for, 75 psychok,g·iLal characreristics of, 26-27 Adolesct'nt girls fantasies about. pregnancy. 11-12 at highest risk for teen pregnancy, 60 mothcr/daught.et relationship, '14-'l'i self-rnncepL and, 8 Adolescent mvtlrcn;, I !>-21 ability ro mother infants. 39-41 rnncept. or th<' ktus. '.18 education and, 46-48 family rc-sponsc to, :i 1-52 groups for. 74-75 inLcrvention programs fo1\ 6�--G7, 72-76 rnoUel program for, 73--70 nionalit). 11-·l5 mot . hcr/r.hil<l interaction. i,i poverty and, 3-1, 50-!i I with psychiatric disorders, 6h-(i7 at risk, 66 suici<lc a11empt rate, 10 Adolcsc:cuts 1 xvii-xviii, .�er also Teenage pregnanc) cognitive development, 7-8

Babies, sre Infant.s .Baldwin, \V .. 48 lhrglow, I'., 36 .Bell, R.R., 10 Belmont, L, ,JS Bensman,]., 26 Birth control, see Contraception Black adolescents, sexually acti,· e, JO Bodi image, 37- 38 R11rt, M., 25, 64 Cain, V.S.. 48 Card, JJ., 26, 47--48, 50 Cates, W., :-17, 40, 4£\, ,il Character clisordcr�, 39 Character disturbanu:s. 18 Child abuse, 40-41, 4fi intervention programs for, 71 Cltild support payments, 50 Chilrlbirth famasies of genital injury and, 35 fears roncerning, 12 Children (vi teenage parents), 48-49, 75, see alm Infants 77

Teenage Pregnancy: Impact an Adolescent Development

Chilman, C., 10, 47, 4(1 Cline, D.W., 28 Cobliner. W.G., li-18. 20 Cogniti,·e devclopmem, 7-8 children of adolescent mothers and.

48-4() C:nntraception, I6 18, :l l. :H availability, 62 males and. 25-'.!6. 30 parents' consent and. 6 I primary p1~cycntion program and.

72-7�\ repeated pregnancies a11d, (i l sex education and, 59-60 Cook, l'.W.. 60 Copeland. A.D.. 20. %, 40, -1'1 Coughey. IL 10 Counseling i<.>r abortions. 62. 7:\ for adoption, 6,\-6:, Culture, 5 Currie, .J .13. ((;abriclson ). --lO Cutler. C.A. ((;rail. 4ti Data collection, 7(i Dav care programs. :i I. 7", Dean. J.G. (Gray), 4(j Defenses. 40 Denial abort.ion �nd. :ll>--3i of the pregna11n. ·Hi Depression, 40 child abuse and, !6 postabortion, 'l:i . arrest. �:I Developrn,·nr:,I Developmental crisis, x,·iii-xix Developmental problems, 71 Di,·orce, •Ill. 49. sn also Marriage OoulJle-standard value,. 2(j Orug abuse, x,·iii, 4, 7'.l Dryfoos. .J .. 48 Earp, .J .. 54 Education, 16-17. -16-411..11•1• alw Sex education lur parenting, 74 of teenage f�.u.hcrs. �ti Ego de,elop111c11t, '.I.J. (ill Environn1cn1.al dcprivarion, 4 han.s, I\. (Pannor). 27-2') .Et,·cr. P.. !?8

Failmc-to-thril'c s1 n<lromc, ·11 Families, 51-52 ' influence on teen sexual activit)", 19, 21, 59 single-parent. I (l, '.> l. -lfi. -19-:'\ I Famil1-planning, 6 °, clinics, 25 costs of. �) 1 Father, as a 1110<.lel, '.11, ,ec also Adolescent fat hers Fcnilit,. 30 Fetus..:r,, Infants: Prenatal< arc Fielding. W.L., 61 Fisher, S.�I., 'l. 16, Ill.%. -ii Fleck, S.. 30 Flowers. C. ((;oldtarb), Ii. 60 Frit>drnan. LA. (Fidding). (i I Friedman. I.. \I. (Fielding). (i I Frustration tolerance. :I I Furstenberg. F.F .. 16. 28-2\l, -18. !i:! (;ahrielson. I.W., -10 Gender identil), 7 Ciblis. J, 28 Gilligan, C., 7 Gillon, J .W. . ('Jaddson), 20 Gold. E.\I (Wallace), 28 (;old, .J. (Cates). ,15 Goldi.tr!,. J.L.. Ii. liO Coldstein. H. (Wallace). 28 Gordon, \1.. 71 Cra:·.J.D.. ,l(j c;runelxnun, 11. !Aberneth1). l!I. fiO C11ilt. 9. 18, '.·14-,\3. .JO abortion and, '.)7-��8 Hatcher. S.I.., '.\.l. '.18 Health risJ..s. 4:l-.J(i Health services. 28 Health Sen·ices and Centers Atncndmem., or ]!)78. Title \'I. iH 1 Jigh-school dropouts. 4(i--·1 i I lonl<'-visiting program, i-1. 76 Hopeless11css, I 8-1() ldentit, consolidation, GO !dent it i, gender, 7 Jrnmaturit\·, X\'iii, �l,l-:H� adolesce·nt fathers and. 2'.l adolescent rnarri,1g-e and. -19-50 linpulsc gratiliriltiun, :1 I lmp11lsi,it,·. 18. 11·1

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