Trends and determinants of contraceptive use in Rakai District, Uganda, 1995-98.

A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15-49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20-39-year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self-perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary.

Partner effects on a woman's intention to conceive: 'not with this partner'.

CONTEXT: Current definitions of pregnancy intention that are useful at aggregate levels are weak at the individual level. This is especially true in social contexts where childbearing and pregnancy often occur within casual or transient relationships. METHODS: Extensive data on lifetime partnerships and sexual behaviors, including pregnancies and births, from 250 low-income women who had experienced a total of 839 pregnancies are used to explore correlates of intention to conceive, as well as the extent to which women attribute their intentions to a current partnership. RESULTS: Some 57% of reported pregnancies were unintended. Overall, 21% of the women had not wished to conceive at least one of their pregnancies with the partner who impregnated them; that proportion rose to 33% among women who had had only unintended pregnancies. Even among women who had had no unintended pregnancies, 18% had had at least one conception that they had not wanted with their partner at the time of conception. Women were less likely to say they had not wanted to conceive with a particular partner if they were living with that partner than if they were not. The likelihood of not having wanted a pregnancy with a given partner rose with the lifetime number of serious partners. Pregnancies that were not wanted with a particular partner were more than twice as likely to end in abortion as were those that were (33% vs. 14%). CONCLUSIONS: Among these women, the desire to avoid childbearing relates more to the couple involved in the conception than to abstract notions of completed family size. It would therefore be useful to include items pertaining to partner relationships in future studies of pregnancy intention.

Multiple sexual partners among U.S. adolescents and young adults.

CONTEXT: Because many teenagers and young adults fail to use condoms correctly and consistently, the number of sexual partners they have is an important risk factor for sexually transmitted diseases, including HIV. Identifying factors that are associated with having multiple partners can help in the design of disease interventions. METHODS: Data on 8,450 males and females aged 14-22 who participated in the 1992 Youth Risk Behavior Survey were used to examine the prevalence of and factors associated with young people's having multiple partners. RESULTS: In all, 63% of female respondents and 64% of males were sexually experienced. Among those who had had sex during the three months before the survey, 15% and 35%, respectively, had had two or more partners during that period. At each age, the majority of sexually experienced respondents had had more than one lifetime partner; between ages 14 and 21, the proportion who had had six or more rose from 8% to 31% among females and from 14% to 45% among males. In logistic regression analyses, alcohol use, illicit drug use and young age at first coitus were associated with increased odds that females had had two or more partners in the previous three months, and being married lowered the odds; black or Hispanic race or ethnicity, alcohol use and young age at first coitus increased the odds for males, and being married reduced the odds. As the number of reported alcohol-related behaviors increased, the adjusted proportion of respondents who had recently had multiple partners rose from 8% to 48% among females and from 23% to 61% among men. CONCLUSIONS: The strong association between alcohol use and having multiple sexual partners underscores the need to educate young people about the effects of alcohol on partner choice and the risk of infection with sexually transmitted diseases.

PIP: This study estimated the prevalence of having multiple sex partners (MSPs) and examined potential risk factors associated with having MSPs among adolescents and youth in the US. Data were obtained from the 1992 National Health Interview Survey and Youth Risk Behavior Survey among a multistage probability cluster sample that was weighted to represent the youth aged 12-21 years. This analysis was based on a limited sample of 4075 youth who were sexually experienced (SE). Initial factor analysis yielded 2 clusters related to first intercourse: substance use and weapon carrying or fighting. Weapons was excluded due to poor internal consistency. Orthogonal rotation revealed 2 cluster factors: alcohol use and illicit drug use. Cross-tabulations were used to identify potential independent predictors. Logistic regression was used to estimate the independent influence of predictors. Findings indicate that most had 2 or more lifetime partners (LPs). The proportion of those with 6 or more LPs rose from 8% at age 14 to 31% at age 21 among females and from 14% to 45% among males. Only 20% of SE females and 13% of SE males reported 1 lifetime partner. Alcohol use, illicit drug use, and young age at first intercourse were associated with increased odds of females having 2 or more partners in the preceding 3 months. Marriage lowered the odds for both sexes. The same 3 factors, in addition to being Black or Hispanic, increased the odds for males. Increases in alcohol-related behaviors contributed to increases in adjusted proportions of recent MSPs from 8% to 48% among females and from 23% to 61% among males.

The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa.

This article reviews the literature on health consequences of adolescent sexual behavior and child-bearing in sub-Saharan Africa, and the social and cultural context in which they occur. It suggests that, in addressing the most serious health sequelae, sexual intercourse that occurs in early marriage and premaritally must both be considered. Some limitations of the data are noted. Despite the excess risk to which adolescents are exposed, due both to custom and age-related vulnerability, differences between health effects among adult and adolescent women are often differences in degree. They are attributable to behavioral, social, and biological causes, exist in traditional and nontraditional settings, in union and out of union, and are exacerbated by declining ages at menarche, pressures of HIV/AIDS and STDs, and a dearth of appropriate services-especially for young people. Some current interventions are discussed, and the need for policy as well as medical intervention is stressed.

PIP: A review of the literature on the health consequences of adolescent sexual behavior and childbearing in sub-Saharan Africa reveals substantial contextual variation. Among the more general factors impacting on early sexual onset and childbirth are younger age at menarche, erosion of social and cultural controls on premarital sex, the abandonment of pubertal rites of passage, and more widespread schooling. Childbearing at young ages has been associated with pregnancy-induced high blood pressure, anemia and hemorrhage, obstructed and prolonged labor, infection, and higher rates of infant morbidity and mortality. Both cultural and biologic factors elevate the likelihood of transmission of sexually transmitted diseases, including HIV, among female adolescents. Many sequelae common to all adolescents are exacerbated by cultural practices such as genital mutilation. It is often assumed that the health problems of adolescent females will be addressed by general improvements in women's health services. However, the level of care required by adolescents who are delivering a first child is considerably greater than that required by healthy adult women. Moreover, may women's health services are hostile to teens who initiate coitus out of wedlock and may even deny treatment. Ultimately, prevention may depend more on changes in public policy and consideration of cultural context than upon specific programs.

Does the timing of the first family planning visit still matter?

CONTEXT: The timing of a first family planning visit relative to first intercourse can affect the likelihood of an early unintended pregnancy. METHODS: Nationally representative data from the 1982, 1988 and 1995 cycles of the National Survey of Family Growth were used to examine changes in the timing of first family planning visits and to explore the degree to which young women are now more likely than in the past to practice contraception independently of making a visit to a provider. Cox proportional hazards models were used to estimate how background variables, visit status and the initiation of contraceptive use affected risks of unintended pregnancy in the four years preceding each survey. RESULTS: The proportion of women who waited a month or more after their first intercourse to see a provider grew slightly between 1978 and 1995, from 76% to 79%; women waited a median of 22 months after first intercourse in 1991-1995. Any contraceptive use at first intercourse increased among both women who delayed a first visit (from 51% to 75%) and among those whose first visit occurred before their first intercourse or within the same month (from 61% to 91%). Cox proportional hazards analysis suggests that the protective effect of a first family planning visit decreased over the period studied, due in part to the increase in early contraceptive use. CONCLUSIONS: The importance of the first family planning visit appears to be declining, as sexually active young women who delay their first visit increasingly do so because they are already using a provider-independent method (primarily the condom). Thus, a multifaceted approach to providing family planning may now be needed, in which independent method use and visits to providers both play a role.

PIP: The timing of a first family planning visit relative to first intercourse can affect the likelihood of an early unintended pregnancy. Nationally representative data from the 1982, 1988, and 1995 cycles of the National Survey of Family Growth were studied to identify changes in the timing of first family planning visits and to investigate the degree to which young women are now more likely than in the past to practice contraception independently of visiting a provider. The proportion of women who waited a month or more after their first intercourse to see a provider grew from 76% to 79% between 1978 and 1995, with women waiting for a median of 22 months after first intercourse in 1991-95. Any contraceptive use at first intercourse increased among women who delayed a first visit from 51% to 75%, and among those whose first visit occurred before their first intercourse or within the same month from 61% to 91%. The importance of the first family planning visit seems to be declining, as sexually active young women who delay their first visit increasingly do so because they are already using a provider-independent method, mainly the condom. This greater use of the condom is related to the advent of the HIV/AIDS pandemic and the associated broader awareness of condoms' ability to block the transmission of HIV and other STDs.

Adolescents with negative pregnancy test results. An accessible at-risk group.

OBJECTIVE: To estimate nationally what percentage of young women receive negative pregnancy test results before becoming pregnant, to explore their fertility and test histories, and to estimate the potential for intervention at the time of a negative test result. DESIGN: A cross-sectional study in which young women presenting to clinics for pregnancy tests were asked to complete a self-administered questionnaire before test results were known that explored prior pregnancy tests, pregnancies, sexual and contraceptive histories, and childbearing attitudes. SETTING: Fifty-two clinics including hospital, health department, Planned Parenthood, and independent facilities. PARTICIPANTS: A total of 2926 patients aged 17 years or younger requesting pregnancy tests at presentation. RESULTS: Among young women who had ever conceived, 34.2% had a prior negative pregnancy test result and 24.4% had a prior negative test result at a clinic. Almost three of five of the adolescent girls, including both those who had and those who had not conceived, received a negative test result at a clinic before they ever became pregnant. By the age of 14 years, the probability of a negative test result was substantially greater than the chance of a positive test. Many presented for tests even though they were quite certain that they were not pregnant. CONCLUSIONS: Adolescent girls with a negative pregnancy test result may be an appropriate target group for intervention. One fourth of adolescent girls who have a negative pregnancy test may be identified by the health care system on that occasion in time to prevent early childbearing.

Durations of adolescent sexual relationships before and after conception.

PURPOSE: To explore durations of young couples' relationships between meeting and first intercourse, before first conception and for two years following conception and the associations between these durations; to describe the association between these durations and the young women's perceptions of the nature of these relationships. METHODS: Three hundred and seven adolescent women were enrolled in a prospective study while presenting for pregnancy tests (the index event); they were followed for two years in three groups--those with negative tests, those who terminated the pregnancy and those who bore a child. Retrospective information about durations of relationships with first partners and partners at the index event was obtained at baseline; follow-up data was obtained on continuing relationships with the index partner. RESULTS: Durations of relationships between adolescent females and their partners in this sample, both before and after conception, are rarely brief; the median duration of a girl's prior relationship with a partner with whom she conceives is almost two years. Similarly, almost half of the sample is still in a relationship at two years following the index event, a proportion that rises to two-thirds among those who bore a child together. CONCLUSIONS: Contrary to common belief or practice, there may be sufficient time and commitment to include many male partners in intervention programs before, and in parenting programs after, a first conception--a practice which could have positive implications for both adolescent partners and, potentially, for their child.

School-based programs to reduce sexual risk behaviors: a review of effectiveness.

This review was undertaken in recognition of the mounting public health and social problems associated with adolescent sexual behavior and the importance of basing school-affiliated programs designed to reduce sexual risk-taking behavior on sound research. The authors were commissioned by the Division of Adolescent and School Health within the Centers for Disease Control and Prevention, Public Health Service, to review carefully the research on these programs and to assess their impact on behavior. The authors identified 23 studies of school-based programs that were published in professional journals and measured program impact on behavior. They then summarized the results of those studies, identifying the distinguishing characteristics of effective programs, and citing important research questions to be addressed in the future. Not all sex and AIDS education programs had significant effects on adolescent sexual risk-taking behavior, but specific programs did delay the initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These effective programs have the potential to reduce exposure to unintended pregnancy and sexually transmitted disease, including HIV infection. These programs should be replicated widely in U.S. schools. Additional research is needed to improve the effectiveness of programs and to clarify the most important characteristics of effective programs.

When children have children: the teen pregnancy predicament.

Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.

PIP: The birthrate among both white and African-American US young women 15-19 years old declined steadily from 89.1 live births per 1000 women (LB/1000) in 1960 to 51.3 LB/1000 in 1985, as a result of the availability of contraception and abortion. The rate has since risen to 62.1 LB/1000 in 1991. In contrast, the birthrate among unmarried young women 15-19 years old increased from 15.3 LB/1000 in 1960 to 42.5 LB/1000 in 1990. The birthrate among white unmarried adolescents more than tripled over the past three decades. The Johns Hopkins University School of Public Health revealed a rise in overall sexual activity from 28% in 1972 to 50% in 1979 in interviews of a national sample of 15-19 year olds. After the Supreme Court decision in Roe v. Wade, 232,440 abortions were performed in 1973 to 15-19 year olds and that number rose to 444,780 by 1980. Title IX of the Civil Rights Act prohibited the exclusion of girls from schools on the basis of pregnancy. In 1977 the Supreme Court struck down a statute that prohibited the sale of nonprescription contraceptives to minors under 16. Reports by the Centers for Disease Control and Prevention identified 1,559,110 legal abortions in 1987, of which 26.1% were to women younger than 20 years old. The adolescent seeking an abortion faces clinical disclosure and parental consent. According to a 1985 poll, 85% of Americans approve of sex education. Nearly 60% of 12-17 year olds surveyed in 1986 said that they had taken a course or had a class on sex education. However, in a 1988 survey of over 4000 public school teachers, only 84% of teachers were in programs that included sexual decision making, abstinence, and birth control methods. Adolescent childbearing may represent normative behavior for those coping with the stress of poverty. Adolescent pregnancy is associated with low birthweight, preterm labor and delivery, poor maternal weight gain, hypertension, anemia, and sexually transmitted diseases.

Adolescent sexual behavior and childbearing.

PIP: Low self esteem does not explain problems of adolescence, particularly unwanted pregnancy and early childbearing. This intimates that their root causes are personal rather than structural and socioeconomic, thereby allowing us to blame the victim. Contrary to popular opinion, few teens (10%) want to conceive and most teens want something other than pregnancy, indicating a need for effective intervention. Teens who were ambivalent about childbearing 2 years earlier are just as likely to have given birth as those who wanted to conceive. Teens self-concept is based on the reality of their environment, which, for most teens who have given birth, involves chronic unemployment, a culture of single parenthood in which men play no supportive role in the home, and the knowledge that teens who choose to continue to attend school despite having given birth fare the same as those who drop out of school. Structural changes (jobs and career goals), long term intervention, and continuous social support are needed to improve a teen's capacity to make choices, especially those concerning contraception. In other words, motivation must be so strong that conceptions are avoided. No family wants to go on welfare and no woman wants to have a baby while a teenager, but when teens become pregnant, they tend not to choose abortion. If welfare reform creates true opportunity for jobs, it will create the motivation to avoid pregnancy but not reduce the childbearing rate among teens that conceive. Very early maturation is correlated with very early onset of sexual activity. The very best sex education and services are unlikely to be offered at a young enough age in schools. US society is obsessed with and unwilling to talk about sex. The notion of choice is not part of poor America. Interactive interventions providing continuing support are needed to make a difference in adolescent pregnancy.^ieng

Addressing adolescent sexual behavior and childbearing: self-esteem or social change?

PIP: Although onset of sexual intercourse in adolescence without regard to marital status has become normative behavior in the US, teen childbearing (as opposed to abortion) is generally restricted to poor communities. A Baltimore study found that only 5% of low-income urban adolescents desired pregnancy; 47% unequivocally wanted to avoid pregnancy and 48% were ambivalent. However, normative pressures from the cultural milieu were inadequate to overcome these adolescents' ambivalence or resistance to teen parenthood. Socioeconomic factors impeding the ability of these teenagers to avert undesired childbearing included the observation that peers who complete high school and postpone motherhood are no better off financially at age 30 than those who do not, pessimism about the possibility of fulfilling one's dreams or even surviving into adulthood, and community indifference. Programs that seek to strengthen the self-esteem of female adolescents may be helpful in improving the capacity to make good choices, but are insufficient in the absence of changes in the cultural context in which these choices are formulated. As long as schools, housing, social services, and job opportunities in poor communities are comprised, teens cannot be expected to select education and jobs over early childbearing and welfare. Massive social change aimed at altering the life chances of low-income youth is an essential component of any strategy that seeks to reduce the rate of adolescent parenthood. This could involve tutoring, job training and placement, mentoring, and access to real alternatives. An emphasis on self-esteem building as a primary mechanism for effecting social change tends to perpetuate the faulty notion that individual rather than structural factors are responsible for social problems.^ieng

Marital and birth expectations of urban adolescents.

PIP: The formation of attitudes conducive to pregnancy prevention is usually included in the development of adolescent pregnancy prevention programs. This research examines the marital and birth expectations among 3646 adolescents enrolled in grades 7-12 in four inner city schools in 1981-82 in the US. The aim is to assess adolescents' perceptions of life experiences in their social environment, which reveal their beliefs about the social acceptability of birth after marriage. Two of the schools had entirely Black student populations, and two for comparison purposes had a mixed student population comprised of 33% Black students. Results reveal that Blacks reported a higher age for marriage and a lower age of first birth than Whites. Blacks had a lower mean ideal age of first birth than for marriage, while White had a lower mean age of marriage than for first birth. 59.1% of Black teenage females and 55% of Black teenage males reported a first birth ideal less than the marriage age, while 20.4% of White teenage females and 21.1% of White teenage males did so. A comparative graph shows Whites having in-wedlock births around 21 years of age and Blacks having in-wedlock births at 26 years of age. The analysis of the best age of marriage regressed on the best age at first birth indicates that the slopes are parallel, and there is no significant difference between Black and White attitudes. Blacks had an ideal marriage age of about two years later than Whites. In the comparison of survey responses to vital statistics data on legitimacy of first births in Baltimore in 1980, it appears that there is a close correspondence between actual out-of-wedlock status of first births and female adolescent attitudes. This study's findings suggest that both Blacks and Whites expect early births to be premarital and later births to be postmarital. Adolescent experiences affect their perceptions, and teenagers' perceptions are fairly realistic. The interpretation of findings is that Black-White differences reflect both macro-historical change and the microlevel community experiences of young people. Findings support Espenshade's historical analysis. Educational interventions should account for the facts that teenagers' ideal age for marriage is older than their projected ages of first births and that beliefs are influenced by community norms.^ieng

Do adolescents want babies? The relationship between attitudes and behavior.

PIP: A prospective study of 313 Black adolescents who were followed for 2 years after presenting for a pregnancy test at an inner-city clinic in Baltimore suggested the need for greater attention to the concept of ambivalence in analyses of adolescent pregnancy. 80% of respondents were 15-17 years of age, 62% were public assistance recipients, and 76% were from female-headed households. Outcome variables, measured at 6-month intervals during the 2-year study period, included contraceptive use, subsequent pregnancy, and childbearing. At baseline, only 8.5% of respondents indicated a desire to become pregnant, 3.3% stated they did not know, and the remainder expressed a desire not to become pregnant. Thus, when a single question was used to assess attitudes toward childbearing, a negligible percentage was unsure. When a multi-item construct was created and inconsistent responses to questions about the outcome variables were treated as ambivalence, the percentage of teenagers falling into that category rose to 47.3%. Added to the construct were perceptions of sexual partner's wishes, perceptions of contraceptive efficacy, and attitudes toward contraception and abortion. In bivariate analysis, a consistent desire to avoid pregnancy had a significant effect on contraceptive usage and avoidance of pregnancy. Adolescents whose responses to the attitudinal measures were coded as ambivalent/inconsistent were at high risk of non-effective use of contraception, pregnancy, and childbearing. For example, among adolescents who delivered a baby, 63% expressed negative attitudes about contraceptive effectiveness, 58% were ambivalent, and 42% expressed positive attitudes. Similarly, of those who carried a pregnancy to term, 54% were opposed to abortion, 57% were ambivalent, and 40% were pro-choice. Based on these findings, it is recommended that pregnancy counselors go beyond a single direct question regarding pregnancy desire, used several probing questions to assess the strength of the commitment to avoid pregnancy, and seek to strengthen that commitment.^ieng

Abortion among adolescents: research findings and the current debate.

Utilizing research that focuses on adolescents as well as findings in samples which might have special relevance to young, unmarried women, this report summarizes research on the consequences of abortion among adolescents. It discusses prior literature in the area of parental notification and parental consent, subjects on which public opinion is not divided along familiar pro-choice/anti-choice lines. Following a discussion of methodological problems identified in prior research, it reports on a study designed to address these problems in an adolescent population; it discusses implications for the current debate of this and other studies' findings that there are no identifiable adverse sequelae of the abortion process.

PIP: The abortion rate among U.S. teens has increased from 43/1,000 in 1981 to 46/1,000 in 1988, with abortions among teens accounting for 25% of total abortions in the U.s. These rates are significantly higher than those in Canada, England, France, Sweden, and the Netherlands which ranged over 5-26/1,000 in 1981. Prior studies of the physical and psychological consequences of abortions among teens almost unanimously indicate that negative sequelae do not exist. This paper summarizes research on the consequences of abortion among adolescents and discusses literature on parental notification and parental consent. Methodological problems found in prior research are also discussed, followed by a report on a Johns Hopkins University study designed to address these problems in an adolescent population. The Johns Hopkins study supports prior research demonstrating the lack of significant sequelae to abortion among teenage women. The medical consequences of childbearing are worse than those of abortion at all stages of gestation, while abortion even offers considerable advantages in the economic and educational areas. In contrast to mandated parental involvement proposed by the Bush administration, teenage women should be allowed the freedom to choose the less dangerous option of abortion without parental consent just as they are allowed to choose to bear children.

To whom do inner-city minors talk about their pregnancies? Adolescents' communication with parents and parent surrogates.

A study of 334 black, urban teenagers who sought pregnancy tests in two Baltimore clinics in 1985-1986 explored communication between the teenagers and their parents or parent surrogates before the pregnancy test visit and, among those whose test results were positive, before the final pregnancy outcome decision. Of these young women, 66% had discussed the possibility that they were pregnant with a parent (usually the mother) or parent surrogate before the test; an additional 6% had turned to another adult. At a follow-up interview a year later, 91% of those whose test results had been positive reported that they had consulted a parent or parent surrogate before deciding what to do about the pregnancy, and 4% had confided in another adult. The probability that an adolescent would consult a parent before deciding what to do about her pregnancy was higher if she was younger, if she lived with the parent and if she found the parent easy to talk to. A year after the pregnancy test, 88% of the adolescents who had given birth or had had an abortion were satisfied with their pregnancy outcome. Satisfaction was not related to whether the young woman had discussed her decision with a parent. Dissatisfaction was most likely if the parent did not support the final outcome, if someone other than the young woman had made the final decision, or if the final outcome was different from the adolescent's preference at the time of the pregnancy test.

Reasons for delay in contraceptive clinic utilization. Adolescent clinic and nonclinic populations compared.

Because delay in accessing contraceptive services is a serious obstacle to prevention of unintended pregnancy in adolescence, reasons for delay are probed in a junior and senior high school population and compared with results obtained among 435 young black women previously surveyed in 32 U.S. clinics. The 388 students surveyed before exposure to pregnancy prevention services are compared with 422 surveyed after greater than or equal to 2 years exposure to a successful educational/clinical intervention program. Particular attention is paid to reasons cited by those who never utilized services; important reasons cited by all groups include fear that contraception is dangerous (cited by 40.0% at baseline), fear of parental discovery (30.5%), and awaiting "closer" partner relationships (31.3%). The last reason was often cited a year or more after initiating coitus. That the perception of birth control as dangerous is a barrier to contraception is confirmed by the large proportions who cited it among those who had never used clinical services. Programmatic implications of the findings are discussed.

Adolescent pregnancy: the clinician's role in intervention.

Adolescent childbearing has adverse sequelae that are intensified when the onset of sexual activity takes place at a particularly early age. A relationship between the onset of sexual activity and the age of maturation has been demonstrated; as the mean age of menarche has become younger, a greater discontinuity has been created between physical development on the one hand and cognitive and emotional development on the other. Initiatives to prevent early sexual initiation and unintended pregnancy must be designed in that context and with an appreciation of normative social pressures. This report reviews research on adolescent development and sexual behavior, including the relationship between maturation and the onset of sexual activity, the timing of pregnancy risk, clinic utilization and reasons for delay in clinic attendance, and clusters of high-risk behaviors. It discusses the role of clinical interventions, suggesting ways in which those who treat adolescents can assist them in acquiring and maintaining protective behaviors.

Differential characteristics of adolescent pregnancy test patients: abortion, childbearing and negative test groups.

Studies of the consequences of adolescent childbearing report many negative sequelae, but the effects of induced abortion are less studied, and most studies lack appropriate controls for preexisting characteristics. This paper uses baseline data from the intake interview into a longitudinal study of 360 innercity black women (less than or equal to 17 years old) presenting for a pregnancy test at two sites in Baltimore to examine baseline differences between three groups: young women who terminated the index pregnancy and, as controls, those who carried to term and those whose tests were negative. They were interviewed before being told the test result. Education aspirations/achievement, economic well-being, sexual/contraceptive history, psychologic characteristics, and desire for a child were compared. Negative test patients often reveal characteristics suggesting a particularly high risk of pregnancy, e.g., more prior pregnancy tests and a greater desire to conceive. Implications are discussed, emphasizing the need to intervene after a negative pregnancy test with counseling to help avert a future undesired conception.

PIP: Studies of the consequences of teenage childbearing have found negative outcomes, but the effects of induced abortion have not been studied as much. More should be found out about the adolescents who choose abortion, and how they compare with those who choose to have the baby; and those who are no pregnant. Most studies do not have "appropriate controls" for preexisting characteristics. This report uses baseline data from the interviews of a longitudinal study of 360 inner city Black teenagers (or= 17 years) who went for a pregnancy test at 2 places in Baltimore, Maryland. Differences between 3 groups were studied: 1) teenagers who had an abortion; 2) those who carried to term; and 3) those who had negative tests. The last 2 were control groups. They were interviewed before being given the test results, and before they chose an outcome. The 2-year longitudinal study followed 360 young women who came for pregnancy tests at Johns Hopkins Comprehensive Child Care Unit; or Planned Parenthood of Maryland. Those who terminated pregnancy numbered 114; those who had a baby numbered 93; and 100 had negative tests. This was their 1st pregnancy. Mean age at entry was 16.1. There was a somewhat greater economic status among those adolescents who chose abortion. Fewer of those who had babies were in school. The abortion group received fewer medical services in the past year. Psychological differences are shown in tabular form, as in the history of sexual, pregnancy, and pregnancy tests. Abortion and childbearing attitudes are given.

When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy.

A group of 360 black teenage women of similar socioeconomic background who sought pregnancy tests from two Baltimore family planning providers was followed for two years to determine if those who obtained abortions were adversely affected by their abortion experience. After two years, the young women who had terminated their pregnancies were far more likely to have graduated from high school or to still be in school and at the appropriate grade level than were those who had decided to carry their pregnancy to term or those whose pregnancy test had been negative. Those who had obtained an abortion were also better off economically than were those in the other two groups after two years. An analysis of psychological stress showed that those who terminated their pregnancy had experience no greater levels of stress or anxiety than had the other teenagers at the time of the pregnancy test, and they were no more likely to have psychological problems two years later. The teenagers who had obtained abortions were also less likely than the other two groups to experience a subsequent pregnancy during the following two years and were slightly more likely to practice contraception. Thus, two years after their abortions, the young women who had chosen to terminate an unwanted pregnancy were doing as well as (and usually better than) those who had had a baby or who had not been pregnant.