Transcript Correlates of Intentional and Unintentional Pregnancy in a

Addressing The Complexity Of
Teen Pregnancy
Through Various Research Strategies
Kimberly Carter PhD, RN; Radford University, Radford VA
Hila Spear PhD, RN; Liberty University, Lynchburg, VA
Katrina Watson MSN, RN; New River Health District, Christiansburg, VA
Overview of Presentations
• Teen Childbearing Trends Nationally & in NRV
• Research Review of Selected Articles
• Teenage Pregnancy: Experiences of Female
Adolescents
• Correlates of Intentional and Unintentional
Pregnancy in a Rural NRV Teenage Population
Teen Childbearing Trends
Nationally and in NRV
Births for Women 15-19 Years
in U.S. (Rates Per 1000 Women)
60 59.9 58.9
54.4
51.1
50
48.5
40
30
20
10
0
'90 '94 '96
'98 '00
• National
trends
indicate
teenage birth
& pregnancy
rates
declining
• May not
accurately
reflect status
of individual
communities
within nation.
Highest Teen Birth Rate States
Age 15-19, 1999
11 highest
states
Significantly
higher
Teen Pregnancy Outcomes
More than half (56%)
of the 905,000
teenage pregnancies
in 1996 ended in
births (2/3 of
which were
unplanned).
(The Alan Guttmacher Institute: http://www.agiusa.org/pubs/fb_teen_sex.html#20a)
Births for Teenagers in Virginia
(Rates per 1000)
90
81.2
80
66.9
70
60
50
40
53.5
1991
2000
40.8
31.8
30
21.7
20
10
0
15-19
15-17
18-19
• Virginia
demonstrated
significantly
lower birth rates
for teens 15-19
• Declines noted
in live birth,
induced
abortions and
fetal loss.
Teen Pregnancy
in the New River Valley, VA
45
45
40
37.4
35
30.7
30
Rate per
100,000
25
Age
10-19
20
15
10
5
0
VA
NRHD
Local
Source: NRVHD Report Card, 1998
Other Pregnancy Indicators for Local
Community
•
•
•
•
•
•
Highest teen live birth rate
2nd highest infant mortality per 1000
2nd highest % receiving no prenatal care
Highest % low weight live births
Highest % out-of-wedlock births
Highest unemployment rates & population
with Medicaid
• Highest teenage pregnancy terminations,
primarily from natural fetal deaths
Previous Works:
Intention to Become Pregnant in NRHD
(Graham & Carter, 1999)
• Sample: Teens accessing prenatal care at NRHD
• Purpose: To identify specific issues, such as
intention to become pregnant.
• Findings: Nearly 50% of pregnant teenagers
receiving care at health department intended to
get pregnant.
• Implications: Findings inconsistent with national
data that most US pregnancies are unintentional
• May represent potential cultural variation from
other sections of country.
Research Review of Selected Articles
Katrina Watson MSN, RN; New River Health District
Christiansburg, VA
Search Strategies
Collection of Data
• Electronic search of Cumulative Index of
Nursing and Allied Health Literature
(CINAHL) and PSYCHLIT databases
• 20 articles published in
peer reviewed journals
Synthesis of Literature
• Teen pregnancy: Ages 12-19 years
• Many studies dealt with males and
females
• Sample size:
25 – 1.6 million
Themes
• Adolescent thinking about sexual
decisions is complex
• Relationship with a significant person
influenced sexual decision making
• Gender differences in attitudes and
behaviors
• Missed opportunities for prevention at
Primary Care encounters
Practice Implications
• Identifying teens at risk of unintentional and
intentional pregnancy
• Greater understanding of the correlates of
teen pregnancy will allow practitioners to
guide and direct appropriate and
individualized care
• Incorporation of assessment and intervention
in Primary Care settings to reduce missed
opportunities
Teenage Pregnancy: Experiences
of Female Adolescents
Hila J. Spear, RN, PhD
Professor of Nursing, Liberty University
Statement of Significance
To date, relatively few qualitative studies that focus
clearly on the unique experiences of pregnant
adolescents have been done. “While there is a
growing body of research in the areas of adolescent
pregnancy and parenting, less is known about the
personal experiences of these teens” (Lesser et al., 1998, p.
8).
More effective nursing interventions and health
promoting programs can be developed based on a
better understanding of the personal perspectives of
young women who experience pregnancy during
their adolescence.
Research Question
The research question that guided this qualitative
study was:
“What is it like to be pregnant from the personal
perspectives of adolescent females who attend
an alternative school for pregnant teens?”
Sample
Eight students (ages 13-19)
participated, seven were African
American and one was Caucasian.
Two girls had each experienced
one prior pregnancy which
spontaneously aborted during the
first trimester. All participants
were unmarried and planned to
keep their babies.
(Fathers of the babies ranged in age from 16 - 21)
Optimism
Findings
When I found out I was pregnant I said, Great!
Mom was upset at first, now she’s real happy. I’m
more motivated to do better in school. The baby’s
daddy is real supportive. I really didn’t plan to get
pregnant, but I sort of did.
I’m happy, my mom’s happy. The baby’s daddy will
be there to help with the baby. One time I thought
I was pregnant but wasn’t. My boyfriend was
disappointed.
Findings
(continued)
Fighting Behavior
I get along with people real well ‘cept when they run
their mouths. There’s another girl that wants to fight
me. I can’t fight her now ‘cause you could harm the
baby.
I can’t fight if this girl comes up to me and wants to
fight me. I can’t fight because I’m pregnant. There’s
a whole bunch of people I got on a hit list.
Findings
(continued)
Separation of Pregnancy, Parenting, and Marriage
Having a child won’t affect me that much. I don’t
have to grow up faster, ‘cause my mom’s gonna help
me and stuff. I’ll still do all the stuff I used to do.
My family likes my boyfriend, but I’m not gonna
marry him. I don’t want to go through divorce.
What’s the sense of gettin’ married? Maybe when
I’m 40 or 50 .
Nurturance
Findings
(continued)
I think about my baby all the time and talk about his
father and his grandparents, and tell him how much
we all love him. He’s part of me automatically.
That baby is goin’ with me wherever I go. I’m gonna
make sure he has whatever he needs. Some mothers
a lot older than me don’t take good care of their kids.
I know I’ll be a good mother.
Discussion
Surprisingly, most of the participants had physically
fought with other females prior to pregnancy. While
participants stated that they were able to restrain their
fighting during pregnancy, reacting in a physical and
sometimes aggressive mode is cause for concern.
Most studies of impulsivity and aggressive behavior
include only male subjects and focus on antisocial and
criminal behavior (Bjork & Dougherty, 1998; Wadman, 1996).
Fighting behavior by females has been most often
addressed in the context of the dating relationship
(Kreiter & Krowchuk, 1999; Malik, et al., 1997).
Discussion
(continued)
The participants considered pregnancy independent of
parenting and believed that having a child would have
little impact on their personal lives. Adolescents may be
unable able to see the connection between pregnancy
and parenting due to limited ability to think abstractly
(Banker & Swartz, 1998).
Cultural and family beliefs also influenced participants’
perspectives on pregnancy and parenting. Even though
they relied on their mothers to take a prominent role in
the rearing of their children, the participants all
expressed nurturing and caring attitudes toward their
unborn babies.
Implications for Practice and Research
 Offer school-based health services
 Further examination of the phenomenon of fighting
behavior among female adolescents is warranted.
 Ongoing dialogue and exploration are needed to
gain understanding and insight into the personal
experiences of adolescents who experience pregnancy
and childbearing.
Correlates of Intentional and
Unintentional Pregnancy in a
Rural NRV Teenage Population
Purpose
To identify correlates to teen pregnancy
specific to one rural community. Only
then can appropriate initiatives be
enacted to address effectively the
unacceptable fetal outcomes of infant
mortality, low birth weight, and
unintended or earlier than intended
births.
Theoretical Framework
•Demographics
•Family Influence
•Peer Influence
•Knowledge
•Attitudes
Behavioral
choices related to
sexual activity
and pregnancy
prevention
Population and Sample
Target Population
9th grade students at one
SWVA High School
Accessible
Population
Students enrolled in Health
& PE & Vocational Classes
Sample
Convenience due to consent
procedures
Design Issues
• Self-selection bias
• Response set bias
• External Validity
Methodology
• Parental Consent
• Surveys administration
• Survey Tool: Questions derived from SKAT-A
(Johnston, 1997), the Virginia Middle School
Youth Risk Behavior Survey (MSYRBS), Faye
Graham’s survey (Graham& Carter, 1999),
and original questions.
Analysis of Data
• Data entered into Excel file by GTA and
processed by RU Statistical Consultant.
• Frequency tables computed. Three
questions were dummy coded for
analysis.
• Attempts to analyze data with higherlevel statistics.
Findings: Demographics
Perceives themselves to be
• in middle or upper levels of
their 9th grade class
• predominantly collegebound
• fairly active in
extracurricular activities.
Findings: Family Influence
• 77% talked about sex with parents/ family adults
• 65% talked about AIDS/HIV with parents/ family
adults
• 14% believe their sexual behavior is influenced
most by parents
Findings: Peer Influence
30%
25%
20%
15%
Friends
Family
10%
5%
0%
1
2
3+
# of teens
with babies
Findings: Knowledge
100
90
80
70
60
50
40
30
20
10
0
71.6
76.1
Range
25-91.7
Range
25-91.7
Mode
91.7
Mode
83.33
Boys
Girls
Total Score on Knowledge Questions
Findings: Incorrect Knowledge
• Douching a few minutes after having sex is
likely to prevent pregnancy.
(23% incorrect: 47% boys, 14% girls)
• The youngest age that MOST teenage girls
can get pregnant is 12.
(65% incorrect: 87% boys, 57% girls)
• The majority of girls who drop out of high
school, drop out because they are pregnant.
(96% incorrect: 100% boys, 95% girls)
Findings: Incorrect Knowledge
con’t
• What is the most effective form of birth
control?
(21% incorrect: 27% boys, 19% girls)
• Birth control pills must be taken:
(23% incorrect: 40% boys, 16% girls)
Findings: Attitudes Related to
Pregnancy
• Responsibility for using
birth control should be
shared by both the man
and woman
• Birth control clinics
should be located in high
schools
• Teenagers who do not
use birth control want to
get pregnant
Findings: Attitudes Related to
Pregnancy (con’t)
• A pregnant girl should follow the decision of
her parents regarding the pregnancy
• Parents should be responsible for teaching
their children about sex
• To me at this point in my life, a pregnancy
is…
• Becoming a parent at this point in my life
would be…
Findings: Behavioral Choices
BOYS
•
•
•
•
•
2 (14%) ever had sex
1st time - 13 to 15
1 & 3+ Partners
Never used condom
Denied concurrent use
of drugs or alcohol with
sex
•
•
•
•
•
GIRLS
14 (38%) ever had sex
1st time 13-14, 3 < 12
1 (40%), 2 (20%) & 3+
(33%) partners
33% never used condom
40% drank alcohol or used
drugs before having sex
Findings: Behavioral Choices con’t
• 2 girls had living children
• Contraceptive used for those
with children: birth control
pills, rhythm, other
• Contraceptive failure
reasons:
– Not used correctly
– Did not understand
menstrual cycle
– other
Findings: Contraceptive use by
sample…
6
6
4
4
5
2
0
0
Always
2
Occasionally
Girls
0
Rare/Never
Boys
Findings: Contraceptive Not Used…
• Not available (1 boy, 5 girls)
• Partner refused (1 girl)
• Other (6 girls)
Conclusions
• Findings suggest that this college-bound, high
achieving group are at risk for pregnancy and
early sexual intercourse.
• At least one girl is at risk for intentional
pregnancy from this group.
• Unintentional risk exists related to knowledge
deficits, access to contraceptives, and
substance use.
Recommendations
•
•
•
•
Review of sexual education curriculum
Review pre-high school curriculum
Peer educator type programming
Focus on concurrent issues: substance
use, multiple sex partners, under use of
condoms.
Future Studies
• Explore ways to obtain parental consent
and student participation of a more
representative cross sample
• Broaden to age 7-11 grade
• Examine targeted interventions to
reduce pregnancy and sexual related
risk
With Grateful Acknowledgement
• Radford University
Professional
Development Grant
• The school board,
superintendent,
principal, counselors,
school nurse, teachers
and staff at the local
school
For More Information...
• Carter, K.F. & Spear, H. J. ( 2002).
Knowledge, attitudes, and behavior
related to pregnancy in a rural teenage
population. Journal of Community
Health Nursing, 19(2), 65-75.
• Spear, H. J. (2001). Teenage
pregnancy: “Having a baby won’t affect
me that much.” Pediatric Nursing,
27(6), 574-580.