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Am J Prev Med. 1994 Mar-Apr;10(2):108-13.

When children have children: the teen pregnancy predicament.

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Preventive Medicine Residency Program, Johns Hopkins University School of Public Health, Baltimore, MD.


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.


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.

[Indexed for MEDLINE]

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