Pregnancy In Adolescence Essay, Research Paper
In most societies, out of wedlock pregnancy and childbearing violate the optimal life course pattern of completion of schooling, gaining employment, marriage, and then parenthood. The phenomenon of adolescent pregnancy is particularly troubling though. Although this occurrence often results in a personal, as well as very real, social dilemma, it must be recognized from the outset that it is not the behaviors themselves that are problematic, but their timing. Adolescence is a period of intense physical, emotional, cognitive, and social development. For this reason, pregnancy is not only potentially very damaging to the individual’s normal development, but it is also a great challenge to prevent because there is no one method of intervention that will address every adolescent individual’s need.
It is primarily age that makes the adolescent transition to sexual activity and conception a problem. Childbearing and the desire to experience sexual contact are biologically normal once physical maturation has occurred (Dean 34). For this reason, premature sexual activity is unlike the socially unacceptable behaviors from which it is grouped. Illicit drug use, alcohol abuse, and delinquency are damaging at whatever age they occur and are never considered normative by the society at large (Hardy 112). It is the age at which early sexual onset and pregnancy occur that, by placing them generally outside marriage and interfering with what is perceived as a normative progression of life events, defines them as “problem” or “high-risk” behaviors (114).
The age at which an adolescent becomes a parent will in large part determine the severity of the disruption he or she will experience. Such an interruption of the tasks of adolescent development, truncating as it often does the completion of schooling and the opportunity to build a strong, independent life, contributes to the individual and social implications of premature parenting (Dean 45). The issue of age therefore must be central to any analysis of adolescent conception.
Adolescence is a period of flux, of change, and of growth; there is no period, with the possible exception of infancy, in which age plays so important and complex a part (Nathanson 39). The role of chronological age, however, is particularly confusing because the stages of adolescence are timed differently for each individual. Physical, emotional, moral and mental development appear to follow well-described sequences that are similar from one individual to another, but even within one individual, each proceeds on a different track. The timetables observed by these areas of development are often different and rarely in synch (Eisen 262).
Why do the consequences of teenage sexual activity tend to differ with age? Older teenagers of eighteen or nineteen will in general have ceased growing. Those who delay sexual onset until their later teens are more mature in their cognitive and socioemotional development. Many will have finished high school, some will be working, and some will be married (Forrest 210). Their obstetrical risks, if they conceive, will on average be lower than those of younger teens. Their social risks will usually be lower than those of younger teens as well (212).
Pregnant adolescents younger than eighteen, on the other hand, are usually at high risk both medically and socially. They are generally still growing and therefore may be in competition with the fetus for nutrients (Forrest 213). The likelihood of anemia, which is common during the normal adolescent growth spurt, is increased by pregnancy and other complications of pregnancy are frequent. As a result, in the absence of comprehensive and specialized prenatal care, preterm delivery and low infant birth weight occur with higher frequency in this age group than in women who commence childbearing later in life (Hardy 210).
In early adolescence, discontinuities between physical development and emotional, psychological and cognitive development are likely to be most pronounced. An adolescent’s ability to comprehend the consequences of her behaviors, to form stable relationships, to communicate effectively with a partner, or to seek protective counsel may be out of line with what her hormones tell her or tell the world about her (Howard 22). Thus, even when sexual onset is a matter of “choice,” the young person may be as unprepared for it as if it were involuntary or coerced (23). The younger she is, the more problematic each aspect of sexual life may be and the higher the probability that she will experience detrimental consequences from her sexual behavior.
Adolescents are less likely to use contraception at first intercourse the younger they are at that event and less likely to seek prompt assistance in the choice of method (Mosher 110). Even when they adopt a contraceptive method, they are less likely than older teenagers and young adults to use it consistently and effectively (111). Sexually active teens are unlikely to receive timely treatment for sexually transmitted diseases and are unlikely to recognize their need for that treatment (Althaus 174). They are at higher risk for STD’s than any other age group due to biological and psychological attributes. The immature histological structure of the adolescent vaginal epithelium is more prone to infection than a more mature individual (175). Psychologically, denial and a feeling of immunity contribute to unprotected sexual behavior and cause both exposure to and denial of these diseases.
Adolescent women may not recognize or acknowledge pregnancy properly and thus limit their access to safe abortion or early prenatal care (Nathanson 116). Teenagers consistently have abortions later in pregnancy than older women do. Their tendency to deny, delay or have difficulty obtaining an abortion is associated with longer gestation (Ravoira 108). The younger the teenager, the more likely she is to have a later abortion. The tendency to delay has the largest single effect on teenagers’ risks of complications during abortion (110).
Most of these characteristics of adolescent sexual behavior clearly tend to put them at increased risk, but it is a risk that they are not cognitively or emotionally able to appreciate. Elkind speaks of the adolescent’s construction of a “personal fable” that is characterized by a belief in the invincibility of self, and a feeling of being unique and therefore not liable to the risks that pertain to one’s peers (Hardy 67). Such a belief may result in the adoption of risk behaviors in an apparent disregard for others and often in choices that appear irresponsible. This egocentric phase of development comes in early adolescence, which has implications for the ability of those adolescents who initiate sexual activity early to adopt self-protective behavior (Dean 112). The observation that adolescents often act as if they are “immune” to pregnancy is consistent to Elkind’s description: If they see themselves as “different,” neither abstract knowledge nor the observed experience of others translates into an accurate perception of personal risk (Hardy 69).
Planning intercourse is not common among adolescents; the younger they are, the less likely that intercourse will be anticipated. And the younger the teenager, the more likely that intercourse will also be unprotected. An inability to predict and plan for sexual intercourse reflects normal cognitive limitations of adolescents who have only a beginning conception of possibility and a limited orientation to the future (Hardy 73).
An important cognition change in adolescence is the development of abstract thinking (Dean 120). Abstract thinking and clearer sense of time are required to understand messages such as “pregnancy will affect your future.” It is unlikely that young adolescents will absorb this as a message with specific relevance to them or their lives, even when they have been taught the basics of human biology (Nathanson 154). An understanding of sexual biology cannot be taken for granted simply because the facts have been imparted. There is evidence that this information demands a relatively high level of cognitive development before it is adequately comprehended, and without such a cognitive context, sexual information is transformed by children to fit their own cognitive levels (156). Because adolescents have difficulty using present resources to deal with the future, when those whose sexual onset is early fail to foresee and plan for protection despite the fact that they “know better,” they are not “deficient” in their development. They are simply constrained by normal limits to their cognitive capacities (Hardy 72).
An important task of adolescence is the achievement of independence while still living at home with parents (Ravoira 98). It is often difficult for parents to see their offspring turn to peers rather than themselves as role models and counselors, but these are years of growing independence even if a teenager’s standards are firmly rooted in the home. Privacy becomes an essential part of this process, particularly in the realm of sexual behavior. The fear of parental disapproval in preventing youngsters from using preventive behavior is very real. “Fear that my family will find out” is consistently in the top three reasons for having not obtained birth control (101).
Procrastination is a familiar syndrome among teens. Most teenagers need a level of reinforcement to achieve even mundane tasks that present none of the ambivalence and potential conflict associated with the use of contraception. They live in the present an
Functional barriers to clinic access certainly influence clinic utilization by teenagers. For young adolescents, the difficulty of negotiating the health care system is substantial. Practical processes such as scheduling an appointment, finding transportation, maintaining secrecy, undergoing examination and interview, getting and paying for contraception and then using them regularly and effectively are all beyond the capacity of many young teens (Eisen 268).
Although adolescence is seen as a healthy time of life, young adolescents are in a transitional and demanding stage of growth and thus at risk of deficits in nutrition and health. The stress of pregnancy puts additional demands on the bodies of very young women that they may not be able to optimally meet (Dean 125). Consequently, the growing fetus is more likely to be deprived, which can lead to a higher risk of intrauterine growth retardation and low birth rate. Infant size is related to prepregnancy weight of the mother, and many young mothers are small. They may be competing with the fetus for nutrients that are in short supply either because of their socioeconomic status or their eating habits. Even when they consume enough calories, they may be deficient in certain vitamins, iron and calcium (127). The fact that they are biologically mature enough to carry does not imply that they have reached full growth; it may be that small size rather than their need for continued growth puts their infants at risk.
It has been pointed out frequently that the characteristics of the normal teenager are in many ways the antithesis of those required for adequate parenting. The egocentrism and narcissism of youth are in sharp contrast to the mutuality that is required between mother and child or to the empathy that a young mother ideally will demonstrate with her offspring (Nathanson 167). While the adolescent is struggling for independence from her family, her position within the family is changing; she often becomes more, not less, dependent on them for assistance and support during and after her pregnancy. In the cognitive transition from concrete to formal operations, she is called on to solve problems beyond her capacities and to plan for the future for herself and her child (Dean 119). And while still experimenting with roles of her own, she has to define for herself the difficult role of mother (Ravoira 45).
With a phenomenon as multifaceted as teenage pregnancy, effective interventions cannot be neatly categorized. No single program can hope to combat the media messages that bombard young people at every socioeconomic level or the peer pressures that surround them (Eisen 267). Services necessary and effective for one individual may not be for another. Every opportunity must be taken to address the needs of teenagers fully at whatever point they first make contact with the health or education delivery system; they may not be accessible again if that moment is lost. Preventive interventions aimed at helping young people avoid unwanted pregnancies and parenthood have commonly been divided into three general categories: educational programs, reproductive health programs, and a broad category often referred to as “life options” programs (Zabin 225).
Educational interventions are programs designed to increase levels of knowledge about human sexuality, STD’s, conception, contraception, pregnancy, and parenthood (Eisen 261). Education also seeks to enhance the ability of young people to make responsible decisions about their sexuality by supporting or influencing their personal values and by affecting their social perceptions, attitudes and skills (Kirby 253). These programs are usually implemented through schools and include sex education and family life education.
While most agree that education can have a positive effect, especially among younger teens, the programs are so inconsistent across school systems that is it difficult to evaluate them. Teachers report a lack of training and materials to carry out their work, and education in this field is frequently superficial and often omits important areas of information that adolescents require (Kirby 260). Furthermore, youth who are the most at risk for pregnancy are often the most difficult to reach through these programs. For example, with the high dropout rates in many urban schools, services delivered through the schools will miss large proportions of those in need (262).
Preventive reproductive health care includes at its core the provision of medical family planning services. Although contraception counseling and prescription are key components of this type of intervention, other essential elements include pregnancy testing, STD testing and treatment, and the counseling and education related to each of these clinical services (Zabin 225). There is no doubt that access to contraception brings down pregnancy rates and that a widespread clinic network plays a crucial role in averting large numbers of births and abortions. In addition to contraceptive services, pregnancy detection and pregnancy counseling are vital if prenatal is to be initiated promptly and also to permit a true choice of optimal pregnancy outcome (225). Also, the availability of safe and early abortion services is essential to avoid large numbers of unintended births.
Despite all of the positive benefits from clinics, traditional contraceptive facilities have often offered adolescents too little, too late (Zabin 231). With the risk of pregnancy high in the early months of sexual activity and the tendency of teens not to seek medical care before a crisis occurs, this population needs more than the regular clinical services that have often served older women successfully. Clinic services tailored to the needs of teens can have more impact on their behavior than traditional services (230).
More recent innovations have included attempts to intervene with high-risk populations in ways that increase their life options by improving their self-concept and raising their aspirations by improving their skills and hence the opportunities that will become available to them. The models included in this “life options” program are job training, augmented education and tutoring, mentorship and role modeling, as well as a range of programs directed specifically at enhancing self-esteem and self-efficacy (Zabin 228-229).
Programs of this kind address well-recognized problems that are not necessarily concerned with “sex.” The inherent worth of their objectives makes them easy to support, whether or not they demonstrate an impact on the pregnancy rates that they were often designed to address. The only downfall associated with these programs is that they are usually only put into action after a first pregnancy or after a high-risk behavior is adopted (Zabin 232). To be truly “preventive,” they should reach all young people who do not have an optimal environment during their developmental years-and probably also many who do.
With the many developmental complications involved with adolescence, it’s no wonder that teen pregnancy is looked upon as such a serious issue. The adolescent’s changes in physical, emotional, cognitive and social development can lead to a world of complications with the onset of sexual activity and pregnancy. Intervention programs must recognize the complexity of the adolescent and adjust their methods according. Clearly, interventions are needed, and perhaps the most effective programs are the ones that recognize the extreme variation among adolescents not only in terms of race and class, but also developmental stages.
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