Research: Teen pregnancy

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The moral panic over teenage pregnancy is sustained by myths and pseudoscience, primarily an ignorance of socioeconomic confounding factors for negative outcomes. While genetic defects in children such as Down Syndrome famously increase with parental age at birth, autism in children is another risk.

The most commonly circulated soundbite concerning "Teen Pregnancy", is the WHO's claim that "complications during pregnancy and childbirth are the leading cause of death for 15–19-year-old girls globally". The obvious problem with this statement is that natural mortality is already a very low risk for someone giving birth in the 15-19 age range, particularly in western countries. Therefore, it is unsurprising that pregnancy is the single leading cause of mortality in this age group. Indeed, within a single socioeconomic group, childbirth mortality risk only increases with age. Within one sample of teen pregnancies, husband involvement, family support and motivation to seek antenatal care were all related to outcomes, and age was not.

Effects

Physiological - causation or just correlation?

• Palma Honorato et al (2021). "Risks of Adverse Neonatal Outcomes in Early Adolescent Pregnancy Using Group Prenatal Care as a Strategy for Public Health Policies: A Retrospective Cohort Study in Brazil ," Frontiers in Public Health, 2021 Apr, 9:9:536342.

  "The overall incidence of adverse neonatal outcomes (low birth weight and prematurity) was measured as 10.2% (95% CI: 9.7-11.5). Apgar scores collected at 1 and 5 min were found to be normal, and no instance of fetal death occurred. The incidence of low birth weight was 16.1% for the 10-13 age group, 8.7% for the 14-15 age group and 12.1% for the 16-17 age group. The incidence of preterm was measured at 12, 8.5, and 12.6% for adolescents who were 10-13, 14-15, and 16-17 years of age, respectively. Neither low birth weight nor prematurity levels significantly differed among the groups (p > 0.05). The infants born to mothers aged 10-13 years presented significantly (p < 0.05) lower Apgar scores than other age groups, but the scores were within the normal range. Conclusions: Our findings showed lower incidence of neonatal adverse outcomes and no risk difference of neonatal outcomes in younger pregnancy adolescents."

• Perry, R. et al (1996). "Pregnancy in early adolescence: Are there obstetric risks?," Journal of Maternal-Fetal Medicine, Volume 5, 1996 - Issue 6.

  "The purpose of this study was to determine if early adolescence imparts a significant obstetric risk in young primiparas relative to adult primiparas. The records of 239 young primiparas (< 16 years) and 148 older primiparas (18–29 years) were reviewed for demographic information, antepartum complications, mode of delivery, length of labor, episiotomy, lacerations, birthweight, and length of gestation. [...] The incidence of most antenatal complications (chronic hypertension, pregnancy-induced hypertension, placental abruption, placenta previa, premature rupture of the membranes, urinary tract infections, and anemia) were similar between the two groups. Preterm labor and contracted pelvis were more common among the young adolescent, while gestational diabetes was less common. The young primiparas were significantly (P <. 05) less likely to have a Cesarean delivery and to lacerate with vaginal delivery. The length of labor and its stages were similar, as were overall birthweight and length of gestation. Thus, obstetric concerns regarding pregnancy in early adolescence may be unfounded. With the exception of an increased risk for preterm labor, it appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara."

• Lopoo, L (2011). "Labor and Delivery Complications among Teenage Mothers," Biodemography and Social Biology, Volume 57, 2011 - Issue 2.

  "A broad set of academic literatures shows that childbearing is associated with a variety of negative health outcomes for teenage mothers. Many researchers question whether teenage childbearing is the causal explanation for the negative outcomes (i.e., whether there is a biological effect of teenage childbearing or whether the relationship is due to other factors correlated with health and teenage childbearing). This study investigates the relationship between teenage childbearing and labor and delivery complications using a panel of confidential birth certificate data over the period from 1994 to 2003 from the state of Texas. Findings show that compared to mothers aged 25 to 29 having their first child, teenager mothers appear to have superior health in most--but not all--labor and delivery outcomes."

A more recent study, funded by the UN and WHO came to conclusions one assumes those institutions were not expecting:

• Nove, A. et al (2014). "Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries," Lancet Global Health, Mar 2014.

  "We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15-19 to 45-49 years. [...] The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20-24 years (maternal mortality ratio 260 [uncertainty 100-410] vs 190 [120-260] maternal deaths per 100 000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s [...] Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years."

Broader social context

• Duncan, S. (2007). "What's the problem with teenage parents? And what's the problem with policy?," Critical Social Policy, 27, 307–334.

  "The influential UNICEF report Teenage Births in Rich Nations claims that:

  . . . giving birth as a teenager is believed to be bad for the young mother because the statistics suggest that she is much more likely to drop out of school, to have low or no qualifications, to be unemployed or low paid, to grow up without a father, to become a victim of neglect and abuse, to do less well at school, to become involved in crime, use drugs and alcohol. (UNICEF, 2003: 3)

  There are two major problems . First, studies do not always compare like with like; ascribing causal effects to teenage motherhood is pretty meaningless if we compare teen mothers with all mothers, rather than those of a similar age and background. Secondly, linked to this, statistical analysis needs to control for ‘selection effects’. This is a variant of the correlation problem so beloved in statistical textbooks. Variable X may be highly correlated with ‘dependent’ variable Y, but this does not mean that X causes Y; rather both may be caused by an unacknowledged variable A. In this case becoming a young mother may not cause the poor outcomes – in terms of education, employment and income – experienced by many teenage mothers; rather both young motherhood, and poor outcomes, may be caused by pre-pregnancy social disadvantage. In this sense social disadvantage may ‘select’ particular young women, and men, to become teenage parents, and this disadvantage will continue post pregnancy. Teenage parenting may therefore be a part of social disadvantage, rather than its cause. [...]

  In fact there has been a tradition of statistical studies that do try to take account of these selection effects. This type of research began in the USA, and found that the social outcome effects of mother’s age at birth were very small, or as Saul Hoffman (1998: 237) put it in his systematic review of the US research ‘often essentially zero’. Indeed, by their mid/late 20s teenage mothers in the USA did better than miscarrying teenagers with regard to employment and income and this meant, ironically, that government spending would have increased if they had not become young mothers (Geronimus, 1997). [...]

  Since the publication of the SEU report, however, a number of British studies have taken up the ‘natural experiment’ approach, with the same results as in the USA. John Ermisch and David Pevalin (2003), using the British Cohort Study to assess differences between miscarrying and successful teenage pregnancies, found that teen birth has little impact upon qualifications, employment or earnings by 30 years of age. While teenage mothers’ partners were more likely to be poorly qualified or unemployed, and this then impacted on the mothers’, and their children’s, standard of living, this is also akin to a selection effect. In itself, age of birth has little effect. A complementary study using British Household Panel data to follow teenage mothers over time came to similar conclusions (Ermisch, 2003), as does a study by Denise Hawkes (2004) on twins, where only one became a teenage mother. Finally, Karen Robson and Richard Berthoud (2003) used the Labour Force Survey to assess the link between high rates of poverty and high rates of teenage fertility among minority ethnic groups, particularly for the extreme case of Pakistanis and Bangladeshis where both variables are particularly high. They concluded that teen birth has little effect on future poverty, and does not lead to any further disadvantage beyond that experienced by the ethnic group as a whole. [...]

  What these qualitative studies find is that many mothers express positive attitudes to motherhood, and describe how motherhood has made them feel stronger, more competent, more connected to family and society, and more responsible. Resilience in the face of constraints and stigma, based on a belief in the moral worth of being a mother, is one overriding theme (Graham and McDermott, 2005). For some, this has given the impetus to change direction, or build on existing resources, so as to take up education, training and employment (see Graham and McDermott, 2005 for review). [...]

  Not surprisingly, therefore, two of the themes identified in a meta-synthesis of US qualitative studies undertaken during the 1990s are ‘Motherhood as positively transforming’ and ‘Baby as stabilizing influence’ (Clemmens, 2003)."

• Martin O'Flaherty, Sara Kalucza, Joshua Bon (2023). Does Anyone Suffer From Teenage Motherhood? Mental Health Effects of Teen Motherhood in Great Britain Are Small and Homogeneous. Demography, 60 (3): 707–729. doi: https://doi.org/10.1215/00703370-10788364

  "Teen mothers experience disadvantage across a wide range of outcomes. However, previous research is equivocal with respect to possible long-term mental health consequences of teen motherhood and has not adequately considered the possibility that effects on mental health may be heterogeneous. Drawing on data from the 1970 British Birth Cohort Study, this article applies a novel statistical machine-learning approach—Bayesian Additive Regression Trees—to estimate the effects of teen motherhood on mental health outcomes at ages 30, 34, and 42. We extend previous work by estimating not only sample-average effects but also individual-specific estimates. Our results show that sample-average mental health effects of teen motherhood are substantively small at all time points, apart from age 30 comparisons to women who first became mothers at age 25‒30. Moreover, we find that these effects are largely homogeneous for all women in the sample—indicating that there are no subgroups in the data who experience important detrimental mental health consequences. We conclude that there are likely no mental health benefits to policy and interventions that aim to prevent teen motherhood."

• Weiss, Rich (2007). "Study Debunks Theory On Teen Sex, Delinquency," The Washington Post, November 11, page A03.

  "In another example, Arline Geronimus, a University of Michigan professor of health behavior who is now a fellow at Stanford University's Center for Advanced Study, knew that babies born to teenagers are more likely to die in their first year of life than those born to older women.

  "But that is an apples-to-oranges comparison," she said. In New York City, for example, far more teen mothers live in Harlem than on the Upper East Side, she said, and "there are a lot of differences between those groups."

  So Geronimus looked more closely and got a different answer.

  "If you compare Harlem teen moms to Harlem older moms, you find that the kids of the teen moms are actually less likely to die," she said. The reasons include the fact that, unlike older women, poor teenagers are generally not juggling jobs and have older relatives to help.

  It can make sense for poor women to have children when they are quite young, Geronimus concludes, and any effort to change that ought to treat it as an economic problem, not a health education problem.

  In a different re-analysis, Geronimus made another counterintuitive finding. While it is true that, in general, teen mothers are less likely to breast-feed their babies than older moms, it is not true among poor women. Poor teenagers are actually more likely to breast-feed than poor older moms, in large part because the older women have jobs that don't grant them the time to breast-feed or pump milk."

• Arai, Lisa (2009). "What a Difference a Decade Makes: Rethinking Teenage Pregnancy as a Problem," Social Policy and Society, 8, 171-183.

  "Early motherhood was reported, then, to have had a positive impact on the respondents' lives and the lives of those around them, even when pregnancy was unplanned. For those young women who had previously had fraught relationships with parents, birth transformed family dynamics and healed breaches. [...] Women reported motherhood as having benefits, primarily in that it healed family breaches and brought estranged family members together. This was especially the case where women had experienced early life adversity. Popular images of young mothers often depict them as unsupported and alone. Here, women were well-supported and their parenting status was accepted by their families (even though not all parents initially welcomed pregnancy). Many young women were able to work or study with the help of their families. Macintyre and Cunningham-Burley's (1993) observation that teenage mothers are often well-supported and that the loneliest and least well-supported mothers are middle class, married women geographically distant from their families was confirmed here. Against a national picture of low pay, family-unfriendly working practices and the difficulties and expense of securing suitable childcare, the women in the study were assisted in a way that would be unthinkable to many older women. This is not to imply that the young women did not struggle; there seemed little hope of decently paid and satisfying work in their areas, and women reported sporadic episodes of hostility from others in their neighbourhoods. However, supported by their parents, they coped well with the transition to parenthood and were keen to point out the benefits of early motherhood, especially to those strangers who judged them."

Rates

• Duncan, S. (2007). "What's the problem with teenage parents? And what's the problem with policy?," Critical Social Policy, 27, 307–334.

  "This social threat discourse is buttressed by a widespread perception that teenage pregnancy has never been higher. This is despite the fact that teenage birth rates in Britain are no higher than in the supposed 'golden age' of the family of the 1950s, and there have been substantial declines in both rates and absolute numbers since the 1960s and early 1970s (see Table 1). By 2004 only 12 per cent of conceptions were to women aged under 20, and just 0.9 per cent to those under 16, with an even smaller share of births – 7 per cent and 0.6 per cent respectively. Rates are also falling in the USA and other ‘high rate’ countries like New Zealand and Canada."

• Santelli, John S.; Lindberg, Laura Duberstein; Finer, Lawrence B.; and Singh, Susheela (2006). "Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use," American Journal of Public Health, 97(1).

  "However, since 1991 these rates have declined dramatically. Pregnancy rates among 15- to 19-year-olds declined 27% from 1991 to 2000, and birth rates (for which more recent published data are available) dropped 33% between 1991 and 2003."

• Noll, Jennie G.; Shenk, Chad E.; Putnam, Karen T. (2009). "Childhood Sexual Abuse and Adolescent Pregnancy: A Meta-analytic Update," Journal of Pediatric Psychology, 34(4), 366-378.

  "Rates of adolescent pregnancy and motherhood, for all age groups and ethnicities within the United States, are at their lowest levels in recent history. Pregnancy and motherhood rates for adolescents 15-19 years of age have declined 36 and 34%, respectively, since 1991."

Causes and prevention

• Santelli, John S.; Lindberg, Laura Duberstein; Finer, Lawrence B.; and Singh, Susheela (2006). "Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use," American Journal of Public Health, 97(1).

  "Our data suggest that declining adolescent pregnancy rates in the United States between 1995 and 2002 were primarily attributable to improved contraceptive use. The decline in pregnancy risk among 18- and 19-year-olds was entirely attributable to increased contraceptive use. Decreased sexual activity was responsible for about one quarter (23%) of the decline among 15- to 17-year-olds, and increased contraceptive use was responsible for the remainder (77%). Improved contraceptive use included increases in the use of many individual methods, increases in the use of multiple methods, and substantial declines in nonuse. These data suggest that the United States appears to be following patterns seen in other developed countries where increased availability and increased use of modern contraceptives have been primarily responsible for declines in adolescent pregnancy rates. Our findings raise questions about current US government policies that promote abstinence from sexual activity as the primary strategy to prevent adolescent pregnancy."

Excerpt Graphic Library

The Excerpt Graphic Library on Youth Sexuality has some useful information on this topic. These can be right clicked, saved and uploaded into shortform social media debates where character limits are in force.

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  Declining rates of sexual activity among youth (YRBS)
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  Various research on Teen Pregnancy correlational nonsense
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  Sexual Repression - effects on the young
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  Sexual Behavior in youth and its effects
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  Reading on child sexuality
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  Some reading on the effects of intimacy
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  Jane Rule on treatment of youth
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  NCAC: Justification for protecting children from porn has always been moral