The problem of teenage pregnancy

Journal of Family Practice, Jan, 1991 by Martha Cole McGrew, William B. Shore

The Problem of Teenage Pregnancy DR MARTHA McGREW (Family Practice Faculty Development Fellow, University of California, San Francisco): Adolescent pregnancy continues to be one of the most difficult issues that teenagers, their families, and communities face today. It affects us all in some way. The teenage mothers or fathers are often unprepared for parenthood and drop out of school, taking low-paying jobs and never completing their education. The teenagers' parents are often thrust into the role of raising two children--the teenager and his or her child. Further, they find themselves stressed emotionally and economically at a time when they were looking forward to their children becoming self-sufficient. Our medical system is also challenged by adolescent pregnancy, which is by definition high risk. Often there is inadequate prenatal care and less than optimal nutrition. Children of teenage parents typically have more illnesses in the first year of life. [1,2]

Social and educational institutions share in a large portion of the problems of adolescent childbearing. Children of teenage parents frequently live in homes that are near or below poverty level. They often require public assistance for the basics of life: food, clothing, and shelter. There is an increased incidence of school failure and dropout in teenage parents and subsequently in their children. [3]

We would like to begin this Grand Rounds by presenting some statistics on adolescent childbearing.

DR WILLIAM SHORE (Associate Clinical Professor-Department of Family and Community Medicine, UCSF): Statistics from 1980 (those from 1990 are not yet available) indicate that there are approximately 10 million girls in the United States. Approximately 1 out of every 10 girls aged 15 to 19 years becomes pregnant each year. This number has changed little over the past 15 years. Using trends from the previous 10 years, it was estimated that among women aged 15 to 19 years, there were 837,000 pregnancies in 1988> among those teenagers 14 years old or younger, there were 23,000 pregnancies. Of these teenage pregnancies, 75% of those in 15 to 19-years-olds were resolved outside of marriage, and nearly all of those in younger teenagers were resolved outside of marriage. Only 16% of pregnancies to teenagers were intended. Thirty-two percent of unintended pregnancies to all women occur in adolescents. Fifty-five percent (463,000) of the pregnancies in teenagers will result in birth, 9000 of these births to girls under the age of 15 years. The remainder of pregnancies are terminated in abortion. One fifth of all US births are to teenagers and one fourth of all abortions in the United States are obtained by teenagers. [4-6] In one study, 20% of all pre-marital pregnancies among teenagers occurred within 1 month of initiating sexual intercourse. Fifty percent of teenage pregnancies occurred within 6 months of first intercourse. [7]

Adolescent childbearing cost the nation $16.6 billion in 1985. [8] Although adolescent fertility rates are decreasing slightly in the United States, they are still higher in the United States than in most other developed countries. Several studies of childbearing in industrialized countries, published by the Alan Guttmacher Institute in New York, [4,6] compare the United States with Canada, France, the Netherlands, Great Britain, and Sweden. These countries were chosen because of their similarities to the United States in culture, stages of economic and industrial development, and levels of adolescent sexual activity. In addition, these countries had data available on adolescent sexual activity. Not only were the US pregnancy rates higher, but the US birth and abortion rates were higher than the rates of the other countries. The increases in the US abortion rate among teenagers has had little effect on birth rate. [9-11] For the remainder of this discussion, a "sexually active" teenager is defined as one who has experienced intercourse.

DR McGREW: We would like to present one of our own case histories of adolescent pregnancy.

Case Presentation

H.S. was a 15-year-old girl who came to the Family Practice Center with her mother. H.S.'s chief complaint was of morning nausea and vomiting, fatigue, and weight gain. Mother and daughter were both certain that H.S. was pregnant. In fact, good dating and uterine size confirmed that H.S. was at 13 weeks' estimated gestational age.

H.S. had turned 15 years old 4 months earlier and had been sexually active for 6 to 9 months. Her mother knew she was sexually active and had suggested oral contraceptives, which H.S. had been taking. She denied having missed any birth control pills. On the first prenatal visit, her mother brought up the possibility of abortion as an option. H.S. was totally opposed, and her mother supported her in her decision.

H.S.'s past medical history was essentially unremarkable. She denied any previous sexually transmitted diseases and substance abuse. She was currently in the 10th grade at a highly regarded public school and had a B average. H.S. was active in her church and in school. She lived with her mother and an older brother and was close to both. H.S.'s mother had given birth to her first child at 16 years of age. She had remained a single, working parent. H.S.'s former boyfriend (the baby's father) was 18 years old and out of school at the time of conception. H.S. and the baby's father "broke up" 2 months prior to her first prenatal visit. Nevertheless, he continued to be involved and supportive of H.S. He visited her quite often, and with his parents' help, was able to offer a small amount of financial support.