EXPLORING RISK FACTORS THAT CONTRIBUTE TO TEENAGE PREGNANCY
Meuy Chieng Saechao
B.A., California State University, Sacramento, 2010
PROJECT
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2010
EXPLORING RISK FACTORS THAT CONTRIBUTE TO TEENAGE PREGNANCY
A Project
by
Meuy Chieng Saechao
Approved by:
__________________________________, Committee Chair
Serge Lee, Ph.D., MSW
____________________________
Date
ii
Student: Meuy Chieng Saechao
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the Project.
__________________________, Graduate Coordinator ____________________
Teiahsha Bankhead, Ph.D., MSW
Date
Division of Social Work
iii
Abstract
of
EXPLORING RISK FACTORS THAT CONTRIBUTE TO TEENAGE PREGNANCY
by
Meuy Chieng Saechao
Teenage pregnancy continues to be a social problem today due to its continuing rise that
has an adverse impact on the teenager, their families, taxpayers and society as a whole.
Many teenaged girls frequently encounter numerous risks and challenges from family,
community and societal influences. This research project examined risk factors
associated with teenage pregnancy among women residing in Richmond and San Pablo,
California. The participants in this study were required to be eighteen years and older and
had children as teenagers. The major findings reported by the sixty participants
interviewed were: 1) they reported that teenage pregnancy was normal and acceptable in
their community and had a positive reaction when discovering they were pregnant; 2)
they had general sex education prior to their early pregnancies; 3) they reported living in
disadvantaged neighborhoods that contributed to having kids at a young age; and 4) some
trends appeared when the sample was divided by ethnicity that suggested a need for
further research in this area. Implications for social work practice are included.
_______________________, Committee Chair
Serge Lee, Ph.D., MSW
Date:____________________
iv
TABLE OF CONTENTS
Page
List of Tables………………………………………….....................................................vii
Chapter
1. THE PROBLEM……………………..............................................................................1
Introduction ...................…......................................................................................1
Purpose of the Study……………………………………………………………....5
Theoretical Framework…………………………………………………………....6
2. LITERATURE REVIEW……………………………………………………………...8
Introduction…………………………………………………………………….....8
International and National Trends………………………………………………...8
Casual Factors and Socioeconomic Condition……………………………….….13
Social and Environmental Factors……………………………………………….14
Poverty…………………………………………………………………………...16
Social Risks………………………………………………………………………18
Social and Personal Consequences………………………………………………19
Health Concerns………………………………………………………………….19
Drugs, Alcohol and Illicit Activities……………………………………………..20
Childhood Maltreatment and Molestation……………………………………….21
Financial Impact on Societal Cost……………………………………………….22
Educational Impact………………………………………………………………23
Contraceptive Use………………………………………………………………..25
v
Page
Psychological Effects…………………………………………………………….26
Theories of Risky Behaviors Leading to Teenage Pregnancy…………………...27
Teenage Pregnancy Prevention Programs……………………………………….29
3. METHODOLOGY……………………………………………………………………34
Introduction………………………………………………………………………34
Research Design………………………………………………………………….34
Study Population…………………………………………………………………35
Sampling Procedures…………………………………………………………….35
Data Collection and Human Subject Protection..…………………………..........36
Measure Instruments……………………………………………………………..37
Data Analysis…………………………………………………………………….38
Limitations……………………………………………………………………….38
Summary…………………………………………………………………………38
4. DATA ANALYSIS……………………………………………………………………40
Introduction………………………………………………………………………40
Quantitative Findings…………………………………………………………….41
Qualitative Findings……………………………………………………………...48
Summary…………………………………………………………………………50
5. CONCLUSION………………………………………………………………………..51
Overview…………………………………………………………………………51
Limitations……………………………………………………………………….53
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Page
Implications for Social Work Practice..………………………………………….53
Recommendations……………………………………………………………......54
Conclusion……………………………………………………………………….54
Appendix A. Consent Form……………………………………………………………...57
Appendix B. Interview Questionnaire...…………………………………………………58
References………………………………………………………………………………..59
vii
LIST OF TABLES
Table
Page
1
Ethnicity of participants………………………………………………………….41
2
Age of participants……………………………………………………………….42
3
Educational level…………………………………………………………………43
4
City of residence…………………………………………………………………43
5
Current marital status…………………………………………………………….44
6
Age when participants first had child……………………………………………44
7
Total number of children………………………………………………………...45
8
City considered disadvantaged.………………………………………………….45
9
Recipients of government assistance programs………………………………….46
10
Raised in a single parent household……………………………………………...46
11
Access to medical coverage……………………………………………………...47
12
Cultural background that plays a view on the participants………………………47
13
Sex education programs at school………………………………………………..48
viii
1
Chapter 1
THE PROBLEM
Introduction
Many individuals believe that human sexuality is a topic that is off-limits for
public discussion. Many parents are intimidated by speaking to their child about sex
because of social taboos and personal discomfort (Bay Area, TPPI member, 2004). In the
past, there has been a tendency to debate whether schools or parents had primary
responsibility for providing sex education. The 1986 Education Act and 1993 Education
Act both attempted to reduce activity in schools so that sex education was acceptable to
parents (Walker, 2004). Legislation has continually promoted the view that parents have
a key role and the right to withdraw their child from sex education outside the National
Curriculum if desired (Walker, 2004). According to Walker, nine out of ten parents
supports sexuality education in schools due to the increase of HIV/AIDS, STDS, and
other social and personal consequences of teen pregnancy. Presently, young people in the
United States have so much unprotected sex, one in three girls under the age of 20 will
get pregnant, with 80 percent of the pregnancies unplanned (Hoyt & Broom, 2002).
The United States alone has approximately 890,000 teenage pregnancies
occurring each year (Hoyt & Broom, 2002). In 2000, the Bay Area that includes
Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, Santa Cruz, and
Sonoma counties had spent approximately over $153 million in taxpayer costs and $342
million in societal costs to all related teen births (Bay Area TPPI member, 2004). In
2002, the federal government spent over one hundred million dollars on “abstinenceonly-until marriage” programs in which the Bush Administration continued to seek an
2
additional thirty three percent to increase its funds (Bay Area TPPI members, 2004). The
federal definitions of abstinence-only education teaches young people that postponing
sexual activities will increase their social, psychological, and physical well being.
However, researchers’ from a comprehensive sex education perspective have expressed
their concerns that abstinence-only messages are inadequate and contain little or no
information regarding contraceptives or they fail to protect completely from against
pregnancy and STD (Kirby, 2008). Other experts criticize abstinence-only programs for
being quite poor in reducing teenage sexual activity for failing to provide students with a
complete understanding of sexual behavior, pregnancy and HIV/STD prevention
programs (Kirby, 2008). Statistics have showed that instead of lowering the numbers of
teenagers getting pregnant, the numbers remain consistent in abstinence-only programs
(Bay Area TPPI members, 2004). Currently, the Obama administration eliminated more
than $170 million in annual federal funding targeted at abstinence programs after a series
of reports concluded that the approach was ineffective. Instead, the White House is
launching a $114 million pregnancy prevention initiative that will fund only programs
that have been shown scientifically to work (Stein, 2010).
East, Khoo, Reyes, (2006) found that teenage pregnancy has been linked to
several risk factors such as peer pressures, family dynamics, and environmental
influences that causes detrimental effects on their decision making and future outcome.
Other scholars believe that residing in low socio-economic communities that include
almost all developed countries; especially the United States has also contributed to the
problem (East, Khoo, Reyes, 2006). Luthar, Cicchetti, & Becker (2000) reported that
3
teenagers with a history of teenage parents are more likely to become pregnant early and
have difficulties finding resiliency to break out the cycle of early pregnancy themselves;
which ultimately hinders the quality of their lives. Research conducted by the National
Center for Health Statistic (Holmes, 1996) reported that the birth rate of all unmarried
women between the ages of fifteen and forty-four from 1980 to 1995 have increased
50%, which equals to 46.9 births per 1,000. In the state of California, it is only recently
that California’s teenage birth rate has declined dramatically since 1991, but according to
the California Department of Finance predicts that the recent declines will soon reverse
(Bay Area TPPI members, 2004).
Darroch and Singh (1998) reported that the declines in teenage pregnancies can be
view from the changes in sexual behavior and changes in contraceptive use. Some
observers have claimed that the declines are the result of increased abstinence but others
credit both greater abstinence and increased contraceptive use, especially contraceptives.
Darroch & Singh explained that broader societal factors underlie the two mechanisms
such as fear of HIV, sexually transmitted diseases; the changing attitudes about sexuality,
the availability of new contraceptive technologies as well as the strong economy (with its
promise of improved career opportunities for young people), welfare reform (with its
constraints on the terms of public assistance), and greater educational and employment
opportunity may affect these behaviors. Darroch and Singh further reported that since the
early 1990’s, teenage pregnancy birthrates have declined dramatically and have reached
their lowest points since they were first measured in the early 1970s. In 1986, reports of
107 pregnancies occurred per 1, 000 women aged 15 to 19; by 1990, that rate had
4
increased 11% per 1, 000. Within the next years, however, the rate fell by striking 17% to
97% pregnancies per 1,000 teenagers, 9% less than the 1986 rate. The teenage birthrate
followed a similar trend, although the recent decrease has been less rapid. From a level of
50 births per 1,000 women aged 15 to 19 in 1986, the rate rose rapidly to 62 per 1,000 in
1991, an increase of 24%. The next five years saw a turnaround, and in 1996, 54 births
occurred per 1,000 teenage women, a rate still higher than that in 1986, but 12% lower
than the peaks reached in 1991.
Numerous interventions to ameliorate the problem and encourage young people to
delay sexual activities have been implemented (Darroch & Singh, 1998). For example,
funding allocated from federal and state government to local and private entities that aim
to prevent either teenage pregnancy or work to decrease the high number of birthrates.
One of the biggest funded programs called Title X Family Planning Program has helped
many teenagers and their families with family planning services as well as assisting
clinics with responding to the needs of their clients. The Title X Family Planning
Program is the only federal grant program designed to provide comprehensive family
planning and related preventive health services (i.e. counseling, breast and pelvic
examinations, screening for sexually transmitted disease and human immunodeficiency
virus, prevention education) and access to contraceptive services, and by law is given
priority to low-income families (Office of Population Affairs, 2009). In 2007, Congress
granted 283 million dollars for family planning activities that served approximately five
million women and men through a network of more than 4,400 community-based clinics
that included State and local health departments, tribal organizations, hospitals, university
5
health centers, independent clinics, community health centers, faith-based organizations,
and other public and private nonprofit agencies (Office of Population Affairs, 2009).
A study conducted by Boyer and Fine (1992) found that 53 percent of the 535
pregnant teenagers from school and the community programs surveyed reported an
experience of sexual molestation, with half of those experiences involving a family
member. Boyer and Fine (1992) also found that 36 percent of the pregnant teenagers in
their sample reported emotional abuse while they were growing up, and 64 percent
reported evidence of physical abuse and neglect. In another study, 62 percent of 445
teenage parents attending a community program reported coercive sexual experience,
one-third of these at the hands of a family member (Brindis & Jeremy, 1988). Butler and
Burton (1990) found that 54 percent of the teenage mother interviewed reported a
previous sexually abuse expensive. Stevens-Simon and McAnarney (1994) reported that
33 percent of 127 pregnant teenagers in their study reported either physical or sexual
abuse. Despite several researches conducted to understand the factors surrounding
teenage pregnancy, it continues to elude human services providers when finding effective
solutions and interventions. Without having a better understanding of the problem, one
million teenagers will yearly continue to become pregnant. This is a controversy issue
that has a detrimental effect on the teenager, their family and society as a whole (Bay
Area TPPI members, 2004).
Purpose of the Study
The purpose of this study is to identify risk factors that contribute to teenage
pregnancy among women residing in the city of Richmond and San Pablo, California
6
who had who had been pregnant and given childbirth as teenagers. Secondly, this study is
intended to explore the subjective socio-economic factors, cultural factors, and
experiences among this particular demographic population. Finally, this study is
conducted to inform as well as make recommendation to social work practitioners and
other social service providers with a better understanding and knowledge who work or
will work with this particular community.
Theoretical Framework
The problem of risk factors contributing to teenage pregnancy can be view from
an ecological perspective (Hutchinson, 2003). According to Hutchinson, the ecological
perspective looks at person in the environment and the affects it has on its members. The
social environment consists of the different types of interactions with individuals, groups,
and organizations. Whether its face to face contact, homes people live in, involvement in
the community, the different types of jobs and pay that people obtain will affect the
outcome of their lives (Kirst & Hull, 2006). People of all ages, different ethnic
background, and sexual orientation are heavily influence by the activities that goes on in
their environment and without adequate means of support, people’s ability to function as
a wholesome person will diminish (Hutchison).
The aspects of the ecological perspective may illustrate the situations of the
participants interviewed in this research study. The ecological perspective looks at the
teenage mother in her social environment and how the environment has an adverse
impact on her well being if not provided with adequate resources. Many of the
participants in this study have to live with dysfunction within the larger context of the
7
environment such as poor community infrastructure, reduced access to medical benefits,
poor housing opportunity, and lack of educational opportunity. The teenage mother are
also expose to drug activities outside her home, prostitution on the street, gang violence
in the neighborhoods and poverty. These illicit activities have a negative impact and
limits how the teenage views her life and future aspirations due to the sense of
hopelessness, powerlessness and oppression. Basically, the ecological perspective
illustrate that without adequate resources to ameliorate these problems, the likelihood of
early pregnancy, school drop out, dependent on government assistance, chemical
dependency are more likely to occur.
8
Chapter 2
LITERATURE REVIEW
Introduction
It is apparent that teenage pregnancy suffers risks and vulnerabilities at all levels,
from the micro level to the macro level system. Numerous empirical literatures explain
the reasons on social and cultural factors that have contributed to teenage pregnancy.
Researchers in the past and present have sought to understand the “root cause” of the
teenage pregnancy, its relationship to other social problems, the consequences of
adolescent mothers and their children, and monetary costs to society. This chapter
explained some of the academic literature from the 1980s through 2010 regarding teenage
pregnancy and other related issues as deemed appropriate to the researcher’s areas of
focus. Overall, the literature is concentrated in three major areas: (1) international and
national trends; (2) causal factors and socioeconomic condition; `and (3) social and
personal consequences.
International and National Trends
Teenage pregnancy is a public concern in both developed and developing world
(Acharya et. al., 2010). Globally 15 million women under the age of 20 give birth each
year. In the developing world, women under the age of 20 die due to pregnancy related
complications. The risk of death due to pregnancy-related causes is double among
women aged 15 to 19 compared to women in their twenties. Young women are also at
risk of unwanted pregnancies, sexually transmitted diseases and unsatisfactory or coerced
early sexual relationships (Acharya et. al., 2010). In South Asia countries such as India,
9
Pakistan, Sri Lanka, Nepal, Maldives, Bhutan and Bangladesh have high proportions of
teenage pregnancies, since early marriage is common and culturally acceptable,
especially in the South Asian culture; there is a social expectation for a woman to have a
child soon after marriage (Acharya et. al., 2010). A study showed that nearly 60% of all
girls are married by the age of 18 years and one fourth is married by the age of 15
(Acharya et. al., 2010). Within South Asia, the recorded teenage pregnancy rate is highest
in Bangladesh, which is 35% followed by Nepal, 21%, and India, 21%. Acharya et., al,
2010 reported that risk factors for teenage pregnancies in South Asia are: socioeconomic status, educational attainment, cultural factor and family structure. Acharya
and colleagues used a retrospective questionnaire that showed the incidence of teenage
pregnancies is significantly higher in the lower social classes (52%) than in the higher
social classes (26%). Their study also found that Hindu teenagers are more likely to
become pregnant than Buddhist teenagers. Acharya and colleagues explained that
structural and social inequalities, poverty and gender also made young people extremely
vulnerable to teenage pregnancy. Acharya and colleagues study showed that among
teenage mothers who are 13 years old (19%) were significantly less likely to have studied
beyond primary school education compared to mothers who were in their twenties (6%).
Acharya et., al (2010) also found that the teenage girls have low involvement and input in
the decision making of their lives such as their parents without the girl’s consent arranged
most teenage marriages (80%). A higher proportion of adolescent pregnant women (67%)
were found to be part of an extended family, of which just over half (51%) claimed that
the authority over conception remains with their husband in spite of the teenagers’ desire
10
to make their own decisions. The study also noted that teenage pregnant women are not
happy in their marriage but remain unspoken due to not going against their parents’ or
family wishes. Consequently, this leads to negligence of family members towards care
and guidance in teenage pregnancies. In addition, teenage girls are also less likely to visit
health service clinics without their husband’s permission. These family structures and
social norms have forced teenagers to give birth before they are emotionally or physically
ready.
Treffers (2003) stated that teenage pregnancy in industrialized and developing
countries has distinctly different birth rates. Treffers explained that in developed regions
such as North America and Western Europe, there is the availability of effective
contraception; however, teenage pregnancy tends to be unmarried and seen as a social
issue. By contrast, teenage parents in developing countries are often married, and their
family and society may welcome their pregnancy. In sub-Saharan Africa, it has the
highest rate of teenage pregnancy in the world, 143 per 1,000 girls between the ages of 15
to 19. In a report, Locoh (2000) stated that the country of Niger in 1992 had 47% of
women ages 20 to 24 who were married before 15 and 87% before 18 and 18.53% of
those surveyed also had given birth before they were 18 years old.
In developed countries such as the United States, it has the highest rate of teenage
pregnancy and birth in the Western industrialized world, costing a minimum of $7 billion
every year (Abma, Martinez, Mosher, & Dawson, 2004). In 2002, the United States rate
was 75 pregnancies per 1,000 girls, which was higher than the rates for many Western
European countries. Among these Western European countries, the birth rates are only 14
11
to 23 pregnancies per 1,000 teen girls (Abma et., al, 2004). This means that every 1000
females in the United States between the ages of 15 to 19, which is 75% (3 out of 4)
women become pregnant (Guttmacher Institute, 2006). The Guttmacher Institute pointed
out that for older teens, the pregnancy rate gets even higher. For older teens between the
ages of 18 to 19, the pregnancy rate is 126 per 1000. When it comes to racial group,
African Americans shared the highest proportion at 134 pregnancies, followed by
Hispanic, at 132. White has the lowest rate at 48 pregnancies. Martin, Hamilton, Ventura
et al. (2005) explained that the current US birth rate for teenagers is 40 births per 1000,
which is much higher than those in other Western industrialized countries. It has also
been noted that more than 30% of girls in the United States that become pregnant one or
more times before they reach age 20 (National Campaign to Prevent Teen Pregnancy,
2006). In 2001, about 82 % of these teen pregnancies were unintended (Martin et., al,
2005).
(Smith & Elander, 2006) reported that teenage pregnancy is associated with socioeconomic deprivation in almost all developed countries including the United States,
United Kingdom, Finland, Canada, Sweden and France. These countries have been
targeted for preventative interventions because of associations with a wide range of
unfavorable health and social outcomes (Smith & Elander). For example, approximately
90,000 teenage give birth each year that includes 7,000 among girls under the age of 16;
the United Kingdom is second only to the United States in teenage births worldwide and
has the highest teenage pregnancy rate in Europe (Social Exclusion Unit, 1999). Regional
differences are an important feature of the United Kingdom teenage pregnancy problem,
12
with significantly higher rates in northern regions than southern regions (Smith &
Elander, 2006). One study reported a birth rate of 35 to 40 per 1,000 girls aged 11 to 10
in northern regions and 25 to 29 per 1,000 in southern regions (Smith & Elander, 2006).
In one analysis of the United Kingdom, teenage pregnancy rates was analyzed on the
effects of area deprivation when adjustment was made for measures of personal and
household disadvantage, suggesting that “personal deprivation rather than area
deprivation dominate the explanation of teenage childbearing,” and that area deprivation
is important “largely because residence in deprived areas is associated with personal
disadvantage”
In Canada, Langille (2007) reported that in 2002, this country had a pregnancy
rate of 33.9 per 1000 females between the ages of 15 to 19, much lower than the rate that
year for England, Wales and the United State. Langille explained that from 1994 to 2002,
the rate of adolescent pregnancy declined significantly in both Canada and the United
States, but it increased slightly in England and Wales. The reasons for the decrease in
teenage pregnancy in the United States were examined in a study using data from the
National Survey of Family Growth in the years 1995 and 2002. The results were that
improved contraceptive use was the main factor to the decreased rates of teenage
pregnancy. For example, the proportion of female aged 15-19 who reported using an oral
contraceptive during last intercourse alone or in combination with other birth control
methods increased dramatically during this period from 32% to 49%. There were also
finding that reported using an injectable long-acting hormonal contraceptive (e.g., Depo
Provera) which also helped increased, from 8% to 10%. Reports of adolescent not using
13
contraception at last intercourse decreased, from 34% to 18%. Similar studies have not
been conducted in Canada; however, from a national survey in 2002 suggest that
contraceptive use also plays a vital role on the decrease. In that national survey, 39% of
Canadian females in grade 9 and 54% in grade 11 reported using oral contraceptive
during last intercourse; 8% and 6% reported using no contraception, and 7% and 11%
reported using withdrawal method either alone or in combination with other methods
(Langille, 2007).
Casual Factors and Socioeconomic Condition
Moore et., al. (1992) explained that the factors that are associated with early
teenage pregnancy are race, gender, marital disruption, living with a single parent, early
onset of puberty, lack of education, poverty, early use of drugs and alcohol, lower family
income, living in a disadvantaged neighborhood, lack of supportive adults, negative selftalk, sexually active siblings and friends, and even the “community economic base and
labor market conditions for women.” Other research has identified six specific risk
factors for teenage pregnancy: (a) early sexual activity and beliefs about sex, which have
been associated with teenage pregnancy in a number of studies (Moore et., al, 1992). (b)
low expectations about education and achievement in life, which were identified as a key
factor by a major review of the literature on risks for teenage pregnancy (Social
Exclusion Unit, 1999). One study showed that educational expectations were lower
among teenage girls who became pregnant than those who did not. (c) Ignorance about
contraception, which was also identified as a key factor in the same major review (Social
Exclusion Unit, 1999) and has been the focus of numerous sex education interventions.
14
(d) Attitudes about the acceptability of abortion, which are important because the
abortion rate is a key factor differentiated areas of high and low teenage pregnancy rates
(Smith, 1996). (e) Beliefs about love and emotional attachments, which are important
because of research showing that young women’s beliefs about not using contraceptives
when in loving relationships differentiating those who became teenage mothers from
those who did not (Smith, 1996). (f) Use of local services for contraception and sexual
advice, which is important because teenagers may be less reluctant to seek advice about
contraception and sex than has sometimes been assumed (Smith, 2006).
Social and Environmental Factors
Smith and Elander (2006) reported that much of the evidence about socioeconomic deprivation and teenage pregnancy are based on area measures of deprivation.
The rationale for using area measures is that area deprivation may consist of deprived
individuals or families, and may have effects that are not accounted for by the levels of
individual or family deprivation in those areas. Wilson (1996), whose theory of
neighborhood effects on family formation guides much of the empirical work in this area,
described several mechanisms that might link the absence of middle and working class
families in ghetto neighborhoods to problematic adolescent behavior. For example,
Wilson argued that high levels of family instability, concentrated poverty,
unemployment, and single-parent households leads to a deficiency of successful
economic and family role models to “help keep alive the perception that education is
meaningful, that steady employment is a viable alternative to welfare, and that family
stability is the norm not the exception” (Wilson, 1996).
15
Wilson (1996) argued that neighborhood disadvantage gives rise to low selfefficacy and reduced expectations for the future. Interacting financially insecure
neighbors signals few benefits to achieving success in school or work. The lack of
established avenues for educational and economic achievement in poor neighborhoods
means that teenagers in these communities have few opportunities costs to early
childbearing (Wilson, 1996). With lowered educational and occupational aspirations,
young females in disadvantaged communities come to view motherhood-even unmarried
motherhood-as a viable route to adult status and the privileges that accompany it (Wilson,
1996). East, Khoo and Reyes (2006) studied over 125 girls between the ages of 13 to 19
and found that girls who are from relatively high-risk environments, poor families and
have a family history of teenage pregnancy that all the girls were either Latina or African
American. Currently, (Ventura, Abma, Mosher, & Henshaw, 2004) found that Hispanic
and Black ages 15 to 19 have pregnancy rates approximately 3 times higher than nonHispanic White teens. Teenage pregnancies amongst African American are the highest of
all racial groups, in which the broad American public disapproves urban African
American as teen mothers. There is a strong correlation between culture, identity and
privilege that favor certain racial and ethnic groups. Cultural independence and social
inequality between European and African Americans leads African Americans to be
highly visible targets of moral condemnation for their behavior. Since European
Americans are the dominant group, they can put their cultural priorities ahead of African
Americans and provide plenty of resources to inform their youth that child bearing at a
young age are unacceptable as well as exercise their children’s well-being and social
16
justice, while others have a more difficult time (Geronimus, 2003).
Wilson (1996) reported that observed behavioral patterns and underlying norms in
many poverty-ridden minority neighborhoods indicate a high level of serious conflict and
disrespect between men and women. The women, for example, complain that the men are
not good husbands and fathers, spending most of their time on the street rather than at
home. The men, on the other hand, see no compelling reason to marry when there are
many more available women than men. There is a diminished sense of responsibility to
support their children and the mother of the children. Wilson also reported that many
teenagers exhibit characteristics that contribute to their high-risk behaviors. For example,
there is a tendency to disrespect the norms and values of one’s family and the cultures in
which they were raised. Some teens have a low sense of self-esteem that makes them
vulnerable to peer pressures whereas others have an overly extravagant view of
themselves and their ability to avoid negative consequences.
Poverty
Family poverty has also been noted associated to teenage pregnancy (Russell,
2001). One study found that teenagers growing up in a high-risk environment are eight
times more likely to become pregnant (East, Khoo, Reyes, 2006). From 1957 to 1980, the
rate of family poverty rates fell and so did the rate of teen births. However, family
poverty rose since 1980s and the birth rate have risen (East, Khoo, Reyes, 2006). Another
study reported a strong association between the percentage of households receiving
public assistance per zip code area and the teenage birth rate (Kirby, Coyle, & Gould,
2001). The “culture of poverty” theory proposed by Crane (1991) suggested that
17
economic disadvantaged produces a distinctive sets of beliefs and values, including
feelings of marginality, helplessness and inferiority that hinders the youths’ future career
expectations and provides a model of complacency and government dependence. Without
an optimism for the future, girls may seek pregnancy and parenting as their life goal
(Stevens-Simon & McAnarney, 1994).
Life-course adversity models of teenage pregnancy speculate that a life history of
family risk contributes to teenage girls’ likelihood of experiencing early pregnancy
(Russell, 2002). Family risks are those factors that undermine the quality of the family
environment. Many studies have shown that girls raised in single-mother households are
at increased risk of teenage pregnancy (Miller, Benson & Galbraith, 2001). One study
showed that the relation between mothers’ single parenting and daughters’ early
pregnancy persisted even after controlling for family factors associated with father
absence, such as family stress and a low standard of living (East, Khoo, Reyes, 2006).
Many studies have also shown that having a mother or sister who was a teenage parent
increase high chance of the teenager herself becoming pregnant (East, Khoo, Reyes,
2006). Two studies that used statewide data found that girls who had a teenage parenting
sister had up to 6 times higher teenage birth rates than girls who did not have a teenage
parenting sister (Cox, Emans, & Bithoney, 1993). In a nationally representative
longitudinal data from Great Britain indicated that, even after controlling for family,
school, and individual characteristics, daughters of teenage mothers were more likely to
have a teenage birth than daughters of older mothers (Manlove, 1997).
18
Luker (1996) reported that there are several theories about the reasons why so
many teenage mothers living in poverty become pregnant and give birth. Some
researchers hypothesize that teenagers lack impulse control; therefore, they cannot act
responsibly for themselves or for their future children. The lack of impulse control may
account for conception, but for the birth of the child if abortion is perceived as a
legitimate method of contraception. Others view the choice to have a child as a conscious
desire to make a career of welfare dependency. Some professionals and the public believe
that teenage mothers should not be held accountable for their behavior since they are
considered symptom carrier of a troubled social system with few viable economic
opportunities outside of welfare. On the other hand, some blame teenage mothers for
their behaviors, considering them sophisticated and knowledgeable people (Luker, 1996).
Social Risks
The important of influential role of peers in girls’ likelihood of pregnancy has
also been well-documented (Bearman, Bruckner, Brown, Theobald, & Philliber, 1999).
Bearman and Brucker (1999) provided extensive analysis using a large national survey of
American teenage girls that showed for every high-risk friend (i.e. those who are sexually
active or pregnant), girls’ risks of pregnancy increased. This study indicated that peer
risks within a girls’ friendship of network that have had intercourse often have their
friends pressure them to be sexually active. In addition, there is strong evidence that
siblings can also serve as an important socializing agents who can potentially accelerate
teenage sexual initiation (East, Khoo, Reyes, 2006). A culture of sexual promiscuity and
permissiveness among siblings can increase teenage sexual risk-taking behaviors and
19
their risk of pregnancy (East, Khoo, Reyes, 2006).
Social and Personal Consequences
East, Khoo, Reyes (2006) reported that there are many adverse and negative
social consequences of teenage pregnancy such as lower access to higher education, high
divorce rates, premature death of women, population growth, weak and unhealthy
children and single motherhood. Flamer and Davis (1990) reported that teenage mothers
suffer developmental milestone since their life path is alter and they have to assume new
responsibilities, roles, identity such as the “mother,” parent or adult. Early pregnancy
often interrupts the teenager’s development of independence from her parents and the
formation of relationships with peers. Some teen mothers are unable to engage in
activities that their peers are experiencing (Flamer & Davis, 1990). Canada (1986) also
reported negative outcomes of teenage pregnancy, which are the following: 1) increased
communication problems for the teen and her family; 2) developmental delay or no
prenatal care that potentially results in poor pregnancy outcome; 3) long term dependency
on public assistance; 4) failure to complete formal education; 5) homelessness; 6) child
abuse; and 7) disproportionately high infant mortality.
Health Concerns
Teenage pregnancy also presents an important public health issue, which is
associated with negative outcome for the adolescent who become pregnant and for their
children. Compared with babies of older mothers, those born to teenagers are more likely
to have lower birth weights, increased infant mortality, an increased risk of hospital
admission in early childhood, less supportive home environments, poorer cognitive
20
development and, if female, a higher risk of becoming pregnant themselves as teenagers.
Teenage mothers more often than other teenagers are socially isolated, have mental
health problems, and have fewer educational and employment opportunities. The
evidence used to support these associations, however, has often failed to consider that
teenage mothers already have disadvantaged life trajectories (Langille, 2007).
Archary et., al (2010) found in their studies that medical consequences were of
top priority such as: pre-term delivery; still birth, fetal distress, birth asphyxia, anemia,
low birth weight, pregnancy-induced hypertension and spontaneous abortion were most
frequently encountered complications during teenage pregnancy. Poor prenatal care,
smoking, uses of illicit drugs and poor diet is strikingly high and there is a
disproportionately high percentage of physical and mental deficits to the infant (Acharya,
et. al., 2010). Archarya identified that the risk of pregnancy complications was 2.5 times
higher among pregnant teenagers compared to mothers in their twenties. A significant
number of teenage mothers had Vitamin A and iodine deficiency, which results in night
blindness. A north India study has also shown that the prevalence of anemia is high 69
(46%) among teenage mothers, which occurs due to low intake of dietary iron. The
likelihood of pregnancy-induced hypertension (13%) and pre-eclampsia (5%) was
significantly higher among pregnant teenagers compared to the women in their twenties
(Acharya, et. al., 2010).
Drugs, Alcohol and Illicit Activities
Walters et., al. (1997) reported that the consequences of being a poor, inner-city,
single mother also faces drug abuse, drug dealing and prostitution. The media have been
21
quick to spread the news that after some decline in the past years, there has been a
significant increase in drug usage by adolescents. The supporting data have been reported
in two major studies, the 1995 Household Survey and the Drug Abuse Warning Network
(DAWN). The results of the Household Survey indicate that illicit drug use in the age
group of 12 to 17 years old range has doubled since 1992. Overall consumption for this
age group has increased by 78% between 1992 and 1995; 33% increase between 1994
and 1995 alone; 105% increase of marijuana use between 1992 and 1995; and 166%
increase of marijuana use between 1994 and 1995.
Ferguson and Lynsley (1996) conducted a 16-year longitudinal study of 1,000
adolescent in New Zealand reported abusing alcohol. The study reported that teenagers
are between 6.1 to 23.0 times more likely to initiate sexual activity at an early age, have
multiple partners and engage in unprotected intercourse than their non-abusing peers. A
study conducted by the Center of Public Interest Polling at the Eagleton Institute of
Rutgers University (1996) reported that 17% of the New Jersey women polled who had
ever been pregnant said they consumed alcohol even after discovering they were
pregnant; 26% of women smoked during their pregnancy. Contrary to the stereotypes
about minority groups, there are more Caucasian women that smoked than African
American or Hispanic women.
Childhood Maltreatment and Molestation
Research has shown that childhood maltreatment has heightened the risk of
teenage pregnancy (Thornberry, Ireland, Smith , 2001). Maltreatment in children are
found to be connected and affects a child’s behavioral, socio-emotional, and cognitive
22
development. They tend to display low school performance, have disruptive behavior,
high anxieties, low self-esteem and poor social skills with peers (Thornberry, Ireland,
Smith, 2001). Parents who are poor, those with less education, female heads of
household, and parents of color are more likely to have official records of maltreatment.
Interestingly, some studies that focused primarily on the link between sexual abuse and
teenage pregnancy, which collected data indicated the presence of other maltreatment in
the early lives of teenage mothers. Boyer and Fine (1992) found that 36 % of the
pregnant teenagers reported emotional abuse while they were growing up, and 64%
reported evidence of physical abuse and neglect. Stevens-Simon and McAnarney (1994)
reported that 33% of 127 pregnant teenagers in their study reported either physical abuse
or sexual abuse. Boyer and Fine (1992) found that 53 percent of 535 pregnant teenagers
from school and community programs surveyed reported an experience of sexual
molestation, with half of those experiences involving a family member. Boyer and Finer
also reported reported that 62% of 445 teenage parents attending a community program
also reported some form of coercive sexual experiences, and one-third of these are at the
hands of a family member. Butler and Burton (1990) found that 54% of the teenage
mothers reported having previous sexually abusive experience and the effect is not just
sexual or physical abuse, but factors such as race, family structure, poor school
experiences and other risky behaviors also play a significant role.
Financial Impact on Societal Cost
Many of the teenagers who give birth lack financial support. This has become a
national concern by the shifting of the economic burden from the family to the public
23
sector. There are significant public costs associated with teenage pregnancy. Brindis and
Jeremy (1988) explained that in 1985 the United States spent at least $16.65 billion for
teenage pregnancy. The $16.65 billion are costs associated with Aid to Families with
Dependent Children (AFDC), Medicaid, and food stamps and did not include nutrition
programs or special education for children with mental or physical disabilities. If these
births had been postponed until they were in their twenties, the United States could have
saved $6.66 billion dollars (Brindis & Jeremy, 1988). In 2004, the estimated annual cost
to taxpayers of births from mothers who were 19 years old or younger was at least $9
billion dollars (Kirby, Coyle, & Gould, 2001).
Wilson (1996) reported that there is an obvious discrepancy between the growing
sectors of the American economy and the educational skills of current welfare recipients.
If welfare reform proceeds as planned and terminates benefits after 5 years without
thinking the compensatory educational programs necessary and creating realistic entry
level jobs, the consequences will be that millions of children across the country born
from un-educated teenage mothers will live in poverty.
Educational Impact
These teen pregnancies and births have negative consequences, especially for
teens that are between the ages of 15 to 17 year old girls. Brindis and Jeremy (1988)
reported their study that 60% of teenage pregnancy sample (N=57) skipped school on a
daily basis and 40% had repeated a grade in school. Their future prospects decline in a
number of ways and they become less likely to complete high school, less likely to attend
college, more likely to have large families, and more likely to be single parents. Since
24
they have not completed their education, teenage mothers cannot expect to find and keep
jobs that could support both the baby and themselves. They often remain dependent on
their families and on the welfare system. Brindis and Jeremy (1988) reported that
approximately 50% of teenage childbirth resulted in high school dropout and had
multiple children while still teenagers. Since decrease in employment opportunities due
to limited education, teenage mothers seeking government assistance is high. If they do
find work, teen mothers work as much as women who delay childbearing for several
years, but their earnings must provide for a larger number of children (Brindis & Jeremy,
1988).
Teen mothers may also not have developed adequate parenting skills that could
enable them to deal effectively with the challenges of raising a child (Brindis & Jeremy,
1988). The children of teen mothers suffer detrimentally as well. For example, compared
to children born to mothers aged 20-21, children born to mothers aged 15-17 have less
supportive and stimulating home environments, lower cognitive development, worse
educational outcomes, higher rates of behavior problems, higher rates of incarceration
(sons), and higher rates of teenage childbearing themselves (Brindis & Jeremy, 1988).
The effects are much less, for children born to mothers aged 18-19.
Moore and colleagues (1992) reported that 84% of all pregnancies for women
under the age of 20 in 1990 were considered unintentional. For example, one issue is
dating violence. Many of the sexual encounters that lead to pregnancy may have been
coercive in nature. It is also possible that coercive sexual relationships, in general, do not
involve any form of protection from either pregnancy or sexually transmitted diseases
25
(STDs). Moore and colleagues indicated a significant number of teenage women engage
in unprotected sexual activity due to coercion by their male partners. Over half of the
sample cited reported having deal with “men who were angry, aggressive, or assaultive”
(p. 359). In addition to physical violence, teenage women give other reasons why they do
not use protection to prevent pregnancy. Some of the reasons were: simple
procrastination to unrealistic thinking about the probability of pregnancy, ambivalence
about sex, contraception, pregnancy, and concerns about confidentiality in seeking
contraceptive devices (Moore et. al., 1992). In a study by (Waters et. al., 1997) found that
young women said they were afraid to request that their partners use condoms for fear of
the men leaving “stepping off”. When the young men were asked, the women’s fears
were found to be valid. Loneliness and the fear of abandonment are potent threats that
rival the fear of violence as reasons to engage in unprotected sex.
Contraceptive Use
Many teenagers do not consistently and carefully use contraceptives, thereby
exposing themselves to high risks of pregnancy or sexually transmitted disease (STD).
Although young people aged 15-24 represent 25% of the sexually active population, they
account for about half of all new cases of STDs (Walters, et., al, 1997); that is nearly four
million cases of STD each year. In some geographic location, rates are much higher. For
example, in one community, 40% of 14 to 19 year old girls who came to the clinic had an
STD. Rates of STDs are typically higher in the African American and Native American
teens than White teens. Rates of STDs are usually slightly higher for Hispanic teens than
white teens. In 2004 the rates of both gonorrhea and syphilis among African American 15
26
to 19 year olds was about 17 times higher than the rate among White teens (Center for
Disease Control and Prevention, 2005). When 2004 data were analyzed by gender, teen
girls had the highest rates of chlamydia and gonorrhea. This may be related to teen girls
being more physiologically susceptible to infection than older women are, whereas the
rates for teen boys were only slightly lower than the rates for men in their 20’s (Center
for Disease Control and Prevention, 2005).
Psychological Effects
Many teenage girls after becoming pregnant also encounter psychological effects
(Campbell & Field, 1989). There are feelings of ambivalence on whether the pregnancy
was planned or unplanned. The aspects that could be relevant to the expectant mothers’
feelings are the family’s financial status, the mother’s marital status, the support from
family members and the relationship the mother has with the child’s father (Campbell &
Field, 1989). Other considerations that could possibly cause concern for both the
expectant parents are: loss of career goals, possible loss of self-esteem, fears about
assuming the roles of parenting, new addition member to the family, fears about
pregnancy and labor (Campbell & Field, 1989).
Teenagers who are 17 years old and under comprise the highest proportion of
high-risk pregnancies in California (March of Dime-Birth Defects Foundation, 1983).
The teenager experiences both physical and emotional problems during pregnancy.
According to the March of Dimes-Birth Defects Foundation, reported that teenage
mothers ages 15 and under encounter high death rates due to pregnancy complications;
the teenage mother is more likely to be undernourished and suffer premature or
27
prolonged labor; during the first trimester of pregnancy, 7 out of 10 pregnant teenagers
do not see a doctor or visit a clinic; and has poor eating habits such as smoking and using
drugs and alcohol, which increase the risk of having a baby with health concerns.
Theories of Risky Behaviors Leading to Teenage Pregnancy
The most dominant model in understanding the behaviors that some teens
undergo can be view from the Problem Behavior Theory (PBT) (Jessor and Jessor, 1998).
The PBT sets out to help explain the various types of risk ‘problem’ behaviors that
include smoking, drug use, alcohol consumption and sexual behavior. The theory
examines much of the ‘risk’ factors associated with teen pregnancy. In the context of
sexual risk behaviors, Jessor and Jessor (1998) examined whether the variables presented
in PBT helped to predict the onset of first intercourse and contraceptive use among 3,419
young girls in Grades 7, 9 and 11 (ages 12–17 years). The participants completed
questionnaires administered three times over the course of 6 years, and contained items
and scales which were directly reflected in the PBT. The nine conceptual areas were
parental intactness, parental socio-economic status, parenting style, parental influence,
peer substance use/deviance, peer influence, adolescent behavior system (current drug,
alcohol use, etc), and psychological factors (self-esteem, depression, etc.) and traditional
values. More specifically, they found that onset of the first intercourse was predicted by
peer substance use, importance of friends, the extent the young person felt harried and the
belief that it was acceptable to break laws. The use of contraception was better predicted
by family structure, socio-economic variables and self-esteem.
28
Aside from the PBT, there are a number of additional theoretical models that have
been applied to risk behavior. The Quantitative Law of Effect or Matching Law that was
developed by Hernstein in the 1960s (Jessor & Jessor, 1998) to understand animal
behavior, the principle of Matching Law lies in the ‘reinforcement’ experienced to
engage in a choice between two or more human behaviors such as whether or not to use
condoms. The behavior is subject to the balance between reinforcement experienced for
undertaking the behavior and the reinforcement experienced in the environment for
alternative behavior. Although applied to a range of behaviors (such as academic
performance and harm behavior), Matching Law has rarely been used to predict patterns
of sexual behavior. A study of 300 female US-based school students aged 14–19 years.
Questionnaires recorded reinforcement practices as well as frequency of intercourse in
the last 6 months and contraceptive use. The Hernstein’s Law explained that 60% of the
variance in sexual frequency rates and 73% of the variations in contraceptive use (Jessor
& Jessor, 1998).
A further model applied to the prediction of young people’s risk behavior is the
theory development of antisocial behavior. The primary argument of this model is that
parental upbringing determines to what extent the child is at risk from the actions of their
peer groups. In other words, for example, aggressive and inconsistent parental discipline
can increase the child’s association with peer groups who are more likely to engage in
risk behaviors. Association with similarly experienced young people reinforces this
behavior and exposure to risk-taking behaviors (Jessor & Jessor, 1998). In a year-long
longitudinal study of 204 adolescents and parents in the USA hypothesized that low
29
levels of conflict within families lead to positive family relations and high levels of
parental monitoring, which leads to less contact with deviant peer groups and less
engagement in high-risk behaviors. Inadequate parental monitoring, for example, was
measured by how often parents let their child go to places without asking, etc. Using
structured equation modeling, the model was able to explain 52% of the variance in risk
behavior reported in this longitudinal study. Further support of this model was a study of
523 young people aged 14–17 years. Again, a longitudinal design was used, this time
over a period of 18 months. The idea that poor parental monitoring and high levels of
parental conflict lead to greater association with ‘deviant peers’, which in itself resulted in
reporting high-risk behaviors, was able to explain 46% of the variance in this risk
behavior (Jessor & Jessor, 1998).
Teenage Pregnancy Prevention Programs
Duncan et al. (1997) reported a longitudinal study on risk behaviors among 257
young people aged 14–17 years in the USA that emphasis the need to educate and
strengthen young people about the risks of combining substance use and sexual behavior.
Duncan et al. also highlighted the need for intervention in adolescent risk behavior from
resisting peer pressure to engage in drug and alcohol. This is likely to reduce the
incidence of high-risk sexual activity. Despite these requests, the number of initiatives
that have addressed risk behaviors collectively remains limited. Nonetheless, some
programs are making progress towards teenage pregnancy reduction. For example, a
‘Positive Impact Program which specifically targets African-American young men in
Arkansas (USA). This small-scale program is run by 17 adults who advise young men
30
about their community and work activities, and ultimately aim to reduce the incidence of
teenage conception, substance use and violence. This project, however, has yet to be
evaluated. Duncan et al. also documented in more detail two peer-led interventions
undertaken in New Zealand. These interventions aim to tackle a series of ‘important
issues’ in young people’s lives including sex, drugs and alcohol. The intervention call
Peer Sexuality Support (PSS) program trains selected secondary school students to
promote a ‘healthy sexuality culture’ among their peer groups. To achieve this, students
are trained over a period of 5 days through a series of workshops covering a range of
health issues such as body image, communication, gender issues, contraception, STDs,
relationships, coercion and alcohol and drug use specifically in the context of sexual
decision making. The second peer-led project was the Alcohol and Other Drugs (AOD)
project that developed from the ideas generated by the PSS work. The procedure of
training a selection of young people who then influence their peer groups was similar to
the PSS. Once again, the issues of alcohol and drugs in the context of sexual behavior
were highlighted.
Additional two studies reported interventions used primarily to pregnancy
prevention. It argued that by providing alternative opportunities and skills will reduce the
motivation for pregnancy (Duncan et. al, 1997). The first program call the Children’s Aid
Society’s Teen Pregnancy Prevention Program provided recreational services, education
advice, a job club and guaranteed admission to a local college. The intervention included
a large performing arts component in delivering the information. The evaluation showed
that college attendance had increased alongside a reduction in teenage pregnancy rates.
31
Although these community-based interventions do not directly tackle risk behaviors
collectively, they were identified as the most successful types of intervention in reducing
teenage pregnancy rates. Duncan et al. explained that by increasing education and
employment skills through these types of interventions may well reduce the likelihood of
young people engaging not only in pregnancy, but also in a multitude of additional risk
behaviors. Kirby and Coyle (1997) composed the second review paper that covers youth
development programs. Their types of interventions focus more on ‘life options’ or
futures and opportunities. Just like the community-based programs reviewed above, they
aim to reduce pregnancy by decreasing the motivation to become pregnant. Kirby and
Coyle (1997) noted the differences between these programs and the more traditional
intervention programs.
A youth development framework provides mechanisms for youths to fulfill their
basic needs, including a sense of safety and structure, a sense of belonging and
group membership, a sense of self-worth and contribution, a sense of
independence and control over one’s life, a sense of closeness and relationships
with peers and nurturing adults, and a sense of competence. Once these needs are
fulfilled, youths can more effectively build competencies necessary to become
successful and productive adults, and they may become more motivated to avoid
early childbearing. (Kirby & Coyle, 1997; p. 1)
Kirby and Coyle (1997) reviewed eight youth development programs that had at
least some evidence of impact evaluation upon sexual or contraceptive behavior. One
example is the Teen Outreach Program (TOP) that promotes the positive development of
32
young people through volunteer work and group/classroom discussion. The program runs
over the course of 9 months, where the participants meet in small groups for
approximately one hour a week and undertake a minimum of 20 hours of volunteer work
throughout the program time. The class/group discussions explored relationships with
family and peers, their personal values, and aimed to develop ‘life skills’ such as
communication, decision making and goal setting. Kirby and Coyle (1997) explained that
this program has provided ‘some of the most consistent and strongest evidence that a
youth development program has reduced teen pregnancy.’ The evaluation included a
random selection of peers (those that receive the TOP) and a controlled-comparison
group (those that did not receive the intervention). This evaluation was study among 695
students from 25 sites across the USA. The results, from this rigorously designed
evaluation show that the TOP reduced pregnancy rates during the year that the students
participated as well as decrease incidences of school suspension and school drop-out
rates. Suggested reasons for the project’s success was providing young people with
positive engaging skill sets and self-esteem through volunteer work. Kirby and Coyle
(1997) concluded their review on youth development program by highlighting the
importance of improved education, employment and life skills as a means to reducing the
motivations for pregnancy. They identify that these factors play a substantial role in
reducing teenage pregnancy than previous efforts aimed at increasing knowledge, beliefs,
attitudes, skills and contraceptive services.
Walters, et., al (1997) conducted a study of motivation and readiness for change
and the development of self-protective health practices. The data was collected through
33
interviewed from thirty participants. Of the thirty participants, sixteen were residents and
staff who had graduated from a drug treatment program and fourteen were undergraduate
and graduate students, all of whom had been pregnant as teenagers. The result was found
that all the participants had commonality with one another that included childhood
physical and sexual abuse, coercive teenage sexual relationships, early first sexual
contact, early first pregnancies that often due to rape or incest, abortions and chemical
dependency. Walters and colleagues explained that the most effective prevention
programs is essentially to understand the numerous complex of risk factors that affects
the lives of these vulnerable young women.
34
Chapter 3
METHODOLOGY
Introduction
The research design and the methodology used for this project are described in
this chapter. The methodology is broken into multiple sections, which include a
description of the design and the study population of sample. Instrumentation, data
gathering procedures and human subjects will also be explained. Lastly, additional
details about the study limitation will be addressed in the final section of this chapter.
Research Design
A qualitative-exploratory research design was used for this research. Rubin and
Babbie (2008) explained that a qualitative study is “a thicker examination of phenomena
and their deeper meanings. Qualitative descriptions tend to be more concerned with
conveying a sense of what it’s like to walk in the shoes of the people being describedproviding rich details about their environments, interactions, meanings, and everyday
lives” (p. 138). Rubin and Babbie also explained that an exploratory research is “typical
when a researcher is examining a new interest, when the subject of study is relatively
new and unstudied, or when a researcher seeks to test the feasibility of undertaking a
more careful study or wants to develop the methods to be used in a more careful study”
(p. 136). Although there have been many studies conducted on teenage pregnancy, there
are still limited information on exploring the experiences of teenage pregnancy in
relation to their biopsychosocial dimensions such as the socio-cultural, economic and
35
mental health issues among young girls residing in the city of Richmond and San Pablo,
California.
Study Population
The criteria used in selecting the participants for this study were women 18 years
or older who are currently residing in the city of Richmond and San Pablo, California
and had given at least one childbirth when they were between the age 13 to 17. The
significant of this study was to identify risk factors that contributed to their early
pregnancy and explore the biopsychosocial dimensions of socio-cultural, economic and
mental health issues. The goal was to interview and collect at least 50 to 60 participants
in the study in which this researcher was ecstatic to collect 60 participants that included
twenty one Mien, three Cambodian, seven Lao, ten African American, eight Hispanic,
two Filipino, one Hmong, four Caucasian, one Portuguese and three Vietnamese.
Sampling Procedures
The researcher of this Master’s Project recruited the participants using the
snowball sampling. Rubin and Babbie (2008) indicate that snowball sampling is
“implemented by collecting data on the few members of the target population whom one
is able to locate, and then asking those individuals to provide the information needed to
locate other members of that population they happen to know” (p. 343). Some of the
participants in this study are friends, relatives, co-workers and family members of other
participants in the study. Snowball sampling techniques allowed the researcher to
mobilize the accessibility of collecting as many interviews as possible for the study.
36
Data Collection and Human Subject Protection
Before data for the research project can be collected; the researcher must followed
California State University, Sacramento’s Human Subject Protection guidelines by
filling out the application for the protection of the human subjects. The researcher
completed the application form, which includes the purpose of the research project, the
sample population for the research, informed consent to participate in the research, the
protection of the rights as a human subject, the protection of confidentiality and
anonymity. The researcher submitted the application to the researcher’s Project Advisor,
Dr. Serge Lee for approval. Once approved, the researcher submitted the application to
the Committee for the Protec tion of Human Subjects at California State University,
Sacramento, Division of Social Work for review. The committee found this project to be
at minimal risks to participants but all documents were approved. The number for this
project is: 09-10-037 and the expiration date is November 2, 2010.
One of the major guidelines in conducting research is protecting the rights to
privacy and safety of the participants by keeping all collected information secure. The
method used by this Master’s Project kept the collected information in a locked file
cabinet in the researcher’s home that is only accessible to the researcher and her thesis
advisor. This researcher is the sole interviewer, data gatherer and analyst. The
confidentiality of the participates information was highly safeguarded by removing all
personal identifying information from the transcripts with the exception of age, gender,
race, marital status and occupation. This researcher recorded all information gathered on
a notebook for accuracy purposes of reporting the exact words from the participants.
37
Pseudonyms were used to identify the participants. At the conclusion of the study, all
notes recording have been disposed.
This researcher has interviewed the participants face to face in a secure location,
each lasting for about 15-20 minutes. The researcher explained the purpose, procedure,
possible risks and benefits of participating in the study and the participants’ right to
decline or withdraw for answering a particular question. The researcher also passed out
the cover letter for the consent of the participants (see Appendix A). Recording of their
responses has been written on a notebook and on the actual interview questionnaire.
Measure Instruments
The research questionnaire consists of 18 questions (see Appendix B). The
purpose of the questions was to help the researcher focus on specific topics of this
research. The questionnaire was developed by the researcher to gain an in-depth
understanding of the risk factors contributing to teenage pregnancy. The questionnaires
were organized into two different parts of the research. The first part contained 11
questions and collected information about the participant’s background. Each participant
identified their current age, ethnicity, number of children they had before age 18, number
of children they currently have, years of schooling, city they currently reside in, whether
or not they consider their neighborhood to be at a disadvantaged, while pregnant did they
receive government assistance, were they raised in a single parent household, current
marital status, and did they have access to medical coverage with their first pregnancy.
The data collected from this first section gave the researcher the demographic
information of the participants. The second part of the questionnaires focused on the
38
participants’ thoughts on teenage pregnancy, the perceptions their family, friends and
cultural background have towards their early pregnancies, and any other comments
regarding early pregnancy among women living within this demographic area. This
section has six exploratory, open-ended questions.
Data Analysis
Once the interviews were complete, the data was managed through transcribing
each interview from the data collection process. Following maintenance of data, the
researcher analyzed and coded the information. After analyzing the data, the researcher
identifies main themes that emerged from the responses. Categories were then coded to
better assess the results. Major themes were drawn from the data and analyzed in chapter
four.
Limitations
A major concern for testing validity was that participates may have not fully
disclose their personal information due to past trauma, shame or embarrassment. This
can hinder the whole experience needed in the study. To minimize this occurrence, the
interview questionnaire was simple and specific. In addition, participants had to be
currently living in the city of San Pablo and Richmond, California during the time of
their first childbirth. The study was limited to only 60 participants.
Summary
This research project is composed of five chapters. Chapter one includes the
introduction, the purpose of the study and the theoretical framework. Chapter two is
composed of a review of the literature with three sections. The first section discussed the
39
international and national trends. The second section discussed about the causal factors
and socioeconomic condition. The third section discussed about the social and personal
consequences. Chapter three is a description of the methodology. Chapter four is the
analysis of the data collected. In chapter five, a summary of findings is presented along
with recommendations and implications of social work practice.
40
Chapter 4
DATA ANALYSIS
Introduction
This chapter presents the overall findings from the research project. The findings
presented in this chapter examine risk factors that contribute to teenage pregnancy among
women residing in the city of San Pablo and Richmond, California. The first part of the
presentations from the findings is in quantitative data and the second part is in qualitative
data. The quantitative data illustrate the following information: demographic information
(i.e. ethnicity, age, educational level, city of residence, marital status), age when
participants have first child, total number of children, city considered disadvantaged,
recipients of government assistance programs, raised in a single parent household, access
to medical coverage, cultural background that plays a view on the participants, and sex
education at school. The qualitative data provides the general responses from the
participants concerning the following questions: 1) what were your thoughts about
adolescent pregnancy. 2) What do you think about the perceptions your family have
toward you because you became pregnant early? 3) What do you think about the
perceptions your friends have toward you because of your early pregnancy? 4) Do you
think your cultural background play a role on how people view you? 5) What kind of
suggestions do you have young girls to avoid becoming pregnant early? 6) Do you have
any other comments regarding early pregnancy among women living within these
41
demographic areas that you would like to share with me, particularly areas that I have not
asked you above?
QUANTITATIVE FINDINGS
Table 1
Ethnicity of participants
Cumulative
Frequency Percent Valid Percent
Percent
Valid Mien
21
35.0
35.0
35.0
Cambodian
3
5.0
5.0
40.0
Lao
7
11.7
11.7
51.7
10
16.7
16.7
68.3
Hispanic
8
13.3
13.3
81.7
Filipino
2
3.3
3.3
85.0
Hmong
1
1.7
1.7
86.7
Caucasian/White
4
6.7
6.7
93.3
Portuguese
1
1.7
1.7
95.0
Vietnamese
3
5.0
5.0
100.0
60
100.0
100.0
African
American/Black
Total
Table 1 display the frequency distribution on the different ethnicity of the
research participants. Findings indicate that the participants’ ethnicity various in these
geographic areas. Among all participants, 35% was Mien, 5% were Cambodian, 11.7%
were Lao, 16.7% were African American/Black, 13.3% were Hispanic, 3.3% were
Filipino, 1.7% were Hmong, 6.7% were Caucasian/White, 1.7% were Portuguese, and
5.0% were Vietnamese.
42
Table 2
Age of participants
Cumulative
Frequency Percent Valid Percent
Percent
Valid 18-23
7
11.7
11.7
11.7
24-29
19
31.7
31.7
43.3
30-35
6
10.0
10.0
53.3
36-40
9
15.0
15.0
68.3
41-45
9
15.0
15.0
83.3
46-50
7
11.7
11.7
95.0
51-55
1
1.7
1.7
96.7
56-60
1
1.7
1.7
98.3
61-65
1
1.7
1.7
100.0
Total
60
100.0
100.0
Table 2 presents the findings in the participants’ age. Of the participants, 11.7%
were in the 18 to 23 age group, 31.7% were in the 24 to 29 age group, 10.0% were in the
30-35 age group, 15.0% were in the 36-40 age group, 15.0% were in the 41 to 45 age
group, 11.7% were in the 46 to 50 age group, 1.7% were in the 51 to 55 age group, 1.7%
were in the 56 to 60 age group, and 1.7% were in the 61 to 65 age group.
43
Table 3
Educational level
Cumulative
Frequency Percent Valid Percent
Percent
Valid Less than high school
14
23.3
23.3
23.3
High School graduate
24
40.0
40.0
63.3
College
22
36.7
36.7
100.0
Total
60
100.0
100.0
Table 3 presents the findings of the participants’ educational level. A total of
23.3% had received less than a high school education, 40.0% reported a high school
education, and 36.7% reported a college education.
Table 4
City of residence
Cumulative
Frequency Percent Valid Percent
Percent
Valid Richmond
35
58.3
58.3
58.3
San Pablo
25
41.7
41.7
100.0
Total
60
100.0
100.0
Table 4 displays the findings to the participants’ city of residence. A total of
58.3% reported residing in the city of Richmond, and 41.7% reported residing in the city
of San Pablo.
44
Table 5
Current marital status
Cumulative
Frequency
Valid
Percent
Valid Percent
Percent
Single
34
56.7
56.7
56.7
Married
22
36.7
36.7
93.3
Divorced
4
6.7
6.7
100.0
60
100.0
100.0
Total
Table 5 displays the findings to the participants’ current marital status. A total of
56.7% indicated that they are single, 36.7% indicated that they are married, and 6.7%
reported of being divorced.
Table 6
Age when participants first had child
Cumulative
Frequency Percent Valid Percent
Percent
Valid 13
2
3.3
3.3
3.3
14
2
3.3
3.3
6.7
15
8
13.3
13.3
20.0
16
31
51.7
51.7
71.7
17
17
28.3
28.3
100.0
Total
60
100.0
100.0
Table 6 displays the participants’ age when having their first child. Of the
participates, 3.3% participants was age 13, 3.3% participants were age 14, 13.3% were
45
age 15, 51.7 were age 16, and 28.3 were age 17.
Table 7
Total number of children
Cumulative
Frequency Percent Valid Percent
Percent
Valid 1
14
23.3
23.3
23.3
2
20
33.3
33.3
56.7
3
14
23.3
23.3
80.0
4
7
11.7
11.7
91.7
6
5
8.3
8.3
100.0
60
100.0
100.0
Total
Table 7 displays the total number of children that the participants currently have.
A total of 23.3% participants have 1 child, 33.3% participants have 2 children, 23.3% of
participates have 3 children, 11.7% participants have 4 children, and 8.3% participates
have 6 children.
Table 8
City considered disadvantaged
Cumulative
Frequency Percent Valid Percent
Percent
Valid Yes
42
70.0
70.0
70.0
No
18
30.0
30.0
100.0
Total
60
100.0
100.0
Table 8 displays the findings pertaining to whether or not the participants
46
consider their city to be at a disadvantaged. Of the research participants, 70.0% reported
yes and 30.0% reported no.
Table 9
Recipients of government assistance programs
Cumulative
Frequency Percent Valid Percent
Percent
Valid Yes
19
31.7
31.7
31.7
No
25
41.7
41.7
73.3
Refuse
16
26.7
26.7
100.0
Total
60
100.0
100.0
Table 9 presents that 31.7% of the research participants reported they have
receive some type of government assistance and 41.7 reported of receiving no form of
government assistance.
Table 10
Raised in a single parent household
Cumulative
Frequency Percent Valid Percent
Percent
Valid Yes
32
53.3
53.3
53.3
No
28
46.7
46.7
100.0
Total
60
100.0
100.0
Table 10 presents that 53.3% of the research participants reported of being raised
in a single parent household and 46.7% reported of not being raised in a single parent
household.
47
Table 11
Access to medical coverage
Cumulative
Frequency Percent Valid Percent
Percent
Valid Yes
No
48
80.0
80.0
80.0
10
16.7
16.7
96.7
2
3.3
3.3
100.0
60
100.0
100.0
Refuse
Total
Table 11 presents that 80.0% of the research participants received medical
coverage, 16.7% had no medical coverage and 3.3% refused to respond.
Table 12
Cultural background that plays a view on the participants
Cumulative
Frequency Percent Valid Percent
Percent
Valid Yes
31
51.7
51.7
51.7
No
29
48.3
48.3
100.0
Total
60
100.0
100.0
Table 12 presents that 51.7% of the research participants believed that their
cultural background did placed a view on their early pregnancy and 48.3% did not
believe it.
48
Table 13
Sex education programs at school
Cumulative
Frequency Percent Valid Percent
Percent
Valid Yes
37
61.7
61.7
61.7
No
23
38.3
38.3
100.0
Total
60
100.0
100.0
Table 13 presents that 61.7% of the research participants reported of having some
form of sex education provided at school and 38.3% reported of no sex education
provided at their schools.
QUALITATIVE FINDINGS
What were your thoughts about adolescent pregnancy?
Twelve of the sixty participants reported that teenage pregnancy was normal and
acceptable in their community and within their family. Twenty-five participants also
reported that they were happy and scared at the same time. Twenty-three participants
reported that they were excited and knew their lives were going to change with having a
child.
What do you think about the perceptions your family have toward you because you
became pregnant early?
Of the sixty participants, twenty-three stated that their parents were “upset,
disappointed and mad” about their early pregnancies. Nine reported that their parents did
not say anything to them. Eighteen reported that their families were supportive and
49
understanding. Ten reported that their parents initially were “mad and upset” but
eventually they were supportive.
What do you think about the perceptions your friends have toward you because of your
early pregnancy?
Of the sixty participants, six stated that their friends were upset with their
pregnancies because “they knew I messed up and hooked up with the wrong guy and that
I wasn’t ready to be a mom.” Seven reported that their friends stopped calling them to
hang out. Fourteen reported that their friends were supportive and excited about their
pregnancies. Thirty-three reported that their friends did not say anything to them.
Do you think your cultural background play a role on how people view you?
Thirty-one of the sixty participants reported that “yes” their cultural background
does play a role on how people view them. The participants explained that people would
“gossip and put them down,” because of their early pregnancies especially the ones who
were not married. Twenty-nine reported that they did not think their cultural background
had a view on their pregnancy. Some of the participants also explained that it is normal
and expected to have children young in their culture while others explained that they did
not think anything of it.
What kind of suggestions do you have for young girls to avoid becoming pregnant early?
The researcher found that all the participants reported “yes,” for young girls
between the ages of 13 to 17 to postpone sexual intercourse until graduating from high
school or college. Many of the participants suggested that young girls should wait until
they are in a stable relationship and have good jobs in place before having a child. Others
50
suggested that they “should just not do it,” or if they are sexually actively, should use
contraceptives or get on birth control.
Do you have any other comments regarding early pregnancy among women living within
these demographic areas that you would like to share with me, particularly areas that I
have not asked you above?
Majority of the participants reported “no” to this last question. Fifteen out of the
sixty participants reported that they have seen so many young girls living in these areas
that have unprotected sex and have children when they are mentally, physically and
financially not ready.
Summary
In this chapter, the data derived from the interviews were analyzed. Chapter five
is an explanation of the findings, recommendation and conclusion. The implications for
social work practice are also discussed.
51
Chapter 5
CONCLUSION
Overview
Teenage pregnancy is not a new phenomenon in the United Sates. There is much
published literature on this topic. However, there is a disproportion of literature within
certain geographic areas. As a current resident of Richmond and San Pablo, California,
the researcher is aware of the controversy issue surrounding teenage pregnancy that exists
in these communities. The researcher conducted this study to learn about the risk factors
associated with teenage pregnancy in Richmond and San Pablo, California. Through
interviewing the participants, the researcher hopes that more partnership between social
service providers and the youth residing in Richmond and San Pablo can openly discuss
about human sexuality that will promote delaying early pregnancies.
The research found that thirty seven participants in the study openly discussed
their personal views and observations regarding their experiences of early pregnancies.
The participants took the opportunity to share their views that early pregnancy was
normal and acceptable in their community and within their family. They reported being
“happy and excited” when discovered they were pregnant. They also reported that there
were little to no stigmas from family and friends.
Many of the responses highlighted that living in low socio-economic community
was a major contributing factor to their early pregnancies. Moore et., al (1992) indicated
in the literature review that teenagers growing up in a high-risk environment are eight
times more likely to become pregnant. A staggering number of participants (70%)
52
indicated that they consider residing in a disadvantaged communities that consisted of
frequent shootings, “drive-bys,” fights, gang violence, drug activities (buying and selling
drugs) and prostitution that all has contributed to their early pregnancies.
Findings in this study indicated that growing up in a single parent household is
also a major contributing factor in their early pregnancy as well. Miller et., al (2001)
indicated in the literature review that many studies have shown that girls raised in singlemother households are at increased risk of teenage pregnancy. A little over half of the
participants (56.7%) reported raised in a one parent home.
Findings in this study indicated that over half of the participants (61.7%) had
some form of sexual education in school. The participants reported that they had sex
education from elementary school all the way to freshmen year in high school. This
suggests that the participants had some general knowledge and idea about abstinence,
contraceptive use and birth control to prevent teenage pregnancy. The findings also
indicated that 80% of the participants had their first child between the ages of sixteen and
seventeen. This suggests that perhaps sex education was ineffective or made no
difference in preventing early pregnancy.
The findings also indicated that demographic features also play a role on the high
number of teenage pregnancy among these areas. There are 48% of participants that
identify as Mien and Lao that has the highest teenage pregnancy occurrence. Following
is 16.7% African American and 13.5% Hispanic. This suggests that these groups of
people have significant barrier to practicing safe sex. More advocacies for policies is
53
needed in these two geographic areas to find innovative and strategic ways to promote
teenage pregnancy prevention awareness among these at risk groups.
Limitations
The limitations of this study are the number of participants and the type of
participants interviewed. Only sixty participants were interviewed for this study. The
sample size was limited and restricted only to women eighteen years and older residing in
Richmond and San Pablo, California who had given childbirth as teenagers. As a result,
the findings of this research project cannot be generalized to a larger population or areas.
Another limitation may be that the study lack reliability since it was through a
standardized instrument as well as not having many questions asked regarding their view
for interventions.
Implications for Social Work Practice
It is important for social workers and other social service providers to conduct
more research to understand the risk factors and barriers to teenage pregnancy in order to
seek effective treatment and solution to decrease early pregnancies. Parts of the various
roles of a social worker are getting involved at the micro, mezzo and macro level. This
study would not only benefit the women residing in Richmond and San Pablo, California
but can be apply to mainstream America. At the micro level, this study can help social
workers explore the risk factors of early pregnancies and engage client effectively by
working one-one-one to assist them with their needs. At the mezzo level, social workers
can work alongside other professionals such as peer advocates, teachers, churches and
local organization with assisting young teens on preventative care, which in turn can help
54
them delay early pregnancy and succeed in other areas of life. At the macro level, social
workers and other policy planners can use this study to develop innovative programs to
reduce the number of teenage pregnancy within these demographic areas and provide
resources to best suit the needs of these communities.
Recommendations
Based upon the results of this project, the study revealed that the overall
perceptions and responses of teenage pregnancy were positive and more exposure to
preventative programs are needed. The researcher of this study recommend social
workers to take the initiative to implement the following programs and activities in order
to decrease the high number of teenage pregnancy: 1) Social workers should familiarize
themselves with the risk factors associated with teenage pregnancy and form a
collaborative partnership with this vulnerable population. 2) Establish a teenage
pregnancy panel at community meetings or agencies for past and current teenage mothers
to share their stories with service providers on what the needs are. 3) Implement better
sex education that explains the physical, emotional and social consequences to early
pregnancy along with the different types of contraceptive methods. 4) Lastly, empower
young girls to delay early pregnancy through youth empowerment program.
Conclusion
The purpose of this study was to explore the risk factors that contributed to
teenage pregnancy. The researcher expected that this study would provide some
viewpoints and thoughts from members of the Richmond and San Pablo, California.
Future researchers may be interested in exploring more about the risk factors associated
55
with teenage pregnancy in these two geographic areas that includes participants’
suggestion on how to prevent teenage pregnancy. Future studies should also include
larger samples incorporating participants form other communities and cities nearby.
This researcher hopes that this study will attempt to offer valuable information in
attempt to provide a better understanding in literature and spread awareness of teenage
pregnancy across settings in all levels of human services. It is our responsibility as social
workers to continue to seek innovative ideas that would best serve this population in
order for them to exercise self-determination, autonomy and have meaningful lives.
56
APPENDICES
57
APPENDIX A
Consent Form
You are being asked to participate in a study that will be conducted by Meuy C. Saechao,
a graduate student in the Division of Social Work at California State University,
Sacramento. This study will investigate factors related to adolescent pregnancy among
women ages 18 years or older who had given at least one live birth when they were
adolescence residing in the city of Richmond and San Pablo. You will be asked to
complete several interview questions about your past experiences related to your
pregnancy as an adolescent. Some of the questions may asked about your socio-economic
status, your personal beliefs and values, and your relationships with your family and
friends. The questionnaires may require up to an hour of your time. Some of the items on
the questionnaires may seem personal, so if you don’t want to answer the question you
don’t have to.
You may gain additional insight about adolescent pregnancy, or you may not personally
benefit from participating in this research. However, it is the hope that the results of this
study will be beneficial for human services providers to implement programs that will
provide the most effective services to other pregnant adolescences.
To preserve the confidentiality of your information, this researcher will not ask you to
provide any information that would personally identify you, such as your name, address,
and social security number. Your responses on the questionnaires will be anonymous.
You may use something other than your real name if you wish. With the permission from
you, this researcher will use a note book and audio taped to record our interview session.
Those notes and tapes will be destroyed as soon as the information is transcribed into the
study, and in any event no later than one year after they were made. Until that time, they
will be locked in a cabinet at the researcher’s home.
You will not receive any compensation for participating in this study. If you have any
questions about this study, you may contact Meuy Saechao at (916) 943-8921 or by email at ms242@csus.edu. For additional questions, you may contact my Thesis Advisor,
Dr. Serge Lee at (916) 278-5820 or email him at leesc@csus.edu. For additional
professional help in the City of Richmond and San Pablo, you may contact the Contra
Costa Mental Health at (510) 374-3261. Your participation in this study is entirely
voluntary. There is no inducement for your participation and that you can decline
participation at anytime. Your signature below indicates that you have read this page and
agree to participate in the study. Thank you.
________________________________
Signature of Participant
APPENDIX B
____________________
Date
58
Interview Questionnaire
1) What ethnicity do you identify yourself with? _____
2) How old were you when you had your first child? _____
3) How old are you now? _____
4) How many children do you currently have? _____
5) How many years of schooling do you have? _____
6) What city do you currently live in?
7) At the time of your pregnancy, did you consider your neighborhood or community to
be at a disadvantaged? Yes____
No____, If yes, please explain___________________
8) While pregnant, did you receive any government assistance such as food stamps or
cash assistance? Yes____
No____
Refuse_____ If yes, what type______________
9) As a child, were you raised in a single parent household? Yes____ No_____
Refuse_____
10) What is your current marital status? ________
11) When you were pregnant with your first child, did you have access to medical
coverage? Yes____ No____ Refuse____
12) What were your thoughts about adolescent pregnancy?
13) What do you think about the perceptions your family have toward you because you
become pregnant early?
14) What do you think about the perceptions your friends have toward you because of
your early pregnancy?
15) Do you think your cultural background play a role on how people view you? Yes___
No___
If yes, could you elaborate:__________________________________________________
If no could you elaborate:___________________________________________________
16) If you were in school while pregnant, did your school offer educational program that
would enable you to better understand your early pregnancy? Yes___ No___
17) What kind of suggestions do you have for young girls to avoid becoming pregnant
early?
18) Do you have any other comments regarding early pregnancy among women living
within this demographic area that you would like to share with me, particularly areas that
I have not asked you above?
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