(January 2018) Births to teenage mothers in the United States have hit record lows for eight successive years, but experts are quick to point out that U.S. teen birth rates are far above those in other high-income countries.

Provisional data for 2016 show that the U.S. teen birth rate was 20.3 births per 1,000 females ages 15 to 19. This rate is 9 percent lower than in 2015 (22.3 per 1,000) and 51 percent lower than in 2007 (41.5 per 1,000).1 But other wealthy countries have much lower rates: United Kingdom, 13.9 per 1,000; Canada, 9.4 per 1,000; France, 8.8 per 1,000; and Sweden, 5.7 per 1,000.2

Because teenage mothers and their children face elevated risks of poverty and health problems, preventing unplanned teenage births is a U.S. public policy priority. New research on the dynamics of U.S. early childbearing underscores the importance of effective contraception and suggests that teenagers who have unintended pregnancies are more likely to be in violent, conflictual, and unstable relationships than their peers. Teenagers’ perceptions of the costs and benefits of having a child early also appear to play a role in unintended childbearing.

Use of Less Effective Contraceptive Methods Puts Poorer Teenagers at Risk

Increased contraceptive use by teenagers appears to be driving the recent decline in teen birth rates, a recent article in the Journal of Adolescent Health shows.3

But the contraceptive-use patterns and dynamics of low-income young women’s relationships may put them at greater risk of unintended pregnancies, a University of Michigan study in the journal Demography suggests.4

Yasamin Kusunoki, Jennifer Barber, Elizabeth Ela, and Amelia Bucek find that poor women have fewer but longer relationships, use contraceptives less frequently, and use less effective methods than women from more advantaged backgrounds.

The researchers used data from the Relationship Dynamics and Social Life (RDSL) study, which identified a random sample of 18-to-19-year-old Michigan women and interviewed them weekly on their relationships, sexual activity, and contraceptive use for more than two years. The current analysis is based on almost 850 racially diverse participants from the study’s first year.

Higher rates of unintended pregnancy among young black women in previous studies have fueled speculation that black women may engage in riskier sexual and contraceptive behaviors than their white peers. In fact, young women from both races used contraception with similar frequency and consistency during the study period, and black women had sex less frequently than their peers.

The Michigan researchers also found that although black women did not differ from white women in the number of different contraceptive methods used, they actually had fewer method switches than white women. (Method switches increase the risk of unintended pregnancy.)

After accounting for socioeconomic disadvantage, the main significant difference between black and white women was contraceptive method choice. Black women used oral contraceptive pills less often and relied on condoms more often than their white counterparts.

The perceived side effects of hormonal contraceptives and negative or limited experiences with the health care system may contribute to black women's greater reliance on condoms, Kusunoki suggests. Condoms are highly effective for sexually transmitted infection prevention, she argues, but relying on condoms alone for pregnancy prevention likely contributes to the higher risk of unintended pregnancy among black women.

Relationships Leading to Unintended Pregnancy More Conflictual, Unstable, and Violent

The intimate relationships of young women in their late teens that lead to unintended pregnancy tend to be more conflictual, unstable, and violent than those of their peers, find University of Michigan’s Barber, Kusunoki, Heather Gatny, and Robert Melendez, in a study also based on RDSL data.5

Relationships that lead to pregnancy are more serious (longer lasting and more likely to involve cohabitation) but also experienced higher levels of conflict and violence than relationships that did not lead to pregnancy. Specifically, the pregnant couples were five times more likely to have broken up and gotten back together, and the pregnant women were four times more likely to report that their partner had physically assaulted them (see figure).



By contrast, young pregnant women’s other relationships that did not lead to pregnancy were more like those of their peers on measures of length, seriousness, instability, and conflict.

Interpersonal skills programs could help couples “avoid risky situations” by, for instance, using contraception when having make-up sex after a breakup and not fighting when either partner is drunk or high, suggests William J. Dougherty of the University of Minnesota.6]

Barber, Kusunoki, Gatny, and Melendez find that the men who fathered pregnancies were older, less educated, and more likely to have children with other partners than either the partners of women who did not become pregnant or the pregnant women’s other partners.

“In other words, the men who impregnated women were generally more disadvantaged and had less promising life prospects than all the other men [in relationships with women in the study],” observes Leslie J. Harris of the University of Oregon.7

The researchers also examined the women’s intimate relationships before and after pregnancy, finding that these relationships deteriorated, either breaking up or becoming less serious, as well as becoming more violent following the pregnancy.

Only about 10 percent of the pregnant women previously reported a strong desire to become pregnant, the researchers note. “If the pregnancy could have been avoided in those relationships that are most serious, unstable, and conflictual, those young women may have been in better relationships when they became mothers,” they point out. Contraceptive access for women who want to delay pregnancy is crucial for the well-being of both mothers and their children, they argue.

Additionally, they suggest that “mandating father involvement is not always in the children’s best interest if it increases contact with violent fathers, or increases violence between their parents.” Communication and co-parenting skills training are “more appropriate for relationships that are not violent,” they write.

Further analysis of the RDSL data shows that violent relationships may contribute to unplanned pregnancies by influencing contraceptive use patterns.8 Young women who experienced physical intimate partner violence (IPV) in their current relationship (recently or in the past) were less likely to use contraception than other similar young women. Those who had experienced IPV tended to use condoms inconsistently. These findings are consistent with previous research highlighting the difficulty of negotiating contraceptive use in violent relationships.

The researchers suggest that service providers and program planners “identify specific relationships, as well as specific periods in the relationship,” where the risk of both violence and unplanned pregnancy are high. Based on these findings they recommend that clinicians “discuss young women’s specific relationship experiences, and do so repeatedly, as relationships change across time.”

Positive Attitudes Toward Early Childbearing Linked to Unintended Pregnancy

Perceiving that becoming pregnant and having a child carries more positive than negative personal consequences may also shape whether a teenager has an unintended pregnancy, another study based on the RDSL data finds.9

While a clear majority of the teenagers interviewed at the beginning of the study told the researchers that they did not want to become pregnant, 20 percent perceived that the benefits of an early pregnancy outweighed the costs. Sarah Hayford of Ohio State University and Karen Benjamin Guzzo of Bowling Green State University, joined Kusunoki and Barber in conducting this analysis.

The 18- and 19-year-old women who had the most positive perceptions of a pregnancy’s impact on their personal lives and of their friends’ approval were most likely to become pregnant during the study.

These young women did not see parenthood as conflicting with other goals, such as completing postsecondary education or having the resources to acquire consumer goods, the researchers note.

Young women’s very “personal evaluation of the consequences of childbearing and how a child would fit in to their lives” may contribute to how consistently they use contraception and may help explain unintended pregnancy, the researchers suggest.

In a related study, researchers examined levels of both desire and disinclination for a pregnancy (using a scale of zero to five) among the RSDL participants.10 Young women in serious relationships, who are depressed, and who are not pursuing postsecondary education have more desire for pregnancy and less disinclination, they find. Additionally, young women who grew up in disadvantaged settings—whose households received public assistance when they were children—are most likely to desire a pregnancy and less likely to want to avoid one.

Social environments in which early unintended pregnancies are less stigmatized play a role in shaping attitudes, the researchers suggest. For example, young women with teenage mothers are more likely to desire early pregnancy than their otherwise similar peers. Thus, as these studies and analyses show, an understanding of the dynamics of teenagers’ intimate relationships and attitudes is essential to any policy aimed at preventing teenage births.


This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population research centers was highlighted in this article: Guttmacher Institute, University of Michigan, Ohio State University, University of Texas at Austin, and Bowling Green State University. A portion of an article by Jared Wadley, University of Michigan, was adapted for part of this piece; used with permission.



Paola Scommegna is a senior writer in U.S. Programs at PRB.


References
  1. Brady E. Hamilton et al., “Births: Provisional Data for 2016,” Vital Statistics Rapid Release Report No. 002, June 2017, accessed at www.cdc.gov/nchs/data/vsrr/report002.pdf, on Sept. 5, 2017.
  2. United Nations Population Division, World Population Prospects, “Adolescent Fertility Rate (Births per 1,000 Women Ages 15-19),” accessed at https://data.worldbank.org/indicator/SP.ADO.TFRT?end=2015&name_desc=true&start=2015&view=map, on Dec. 15, 2017.
  3. Laura Lindberg, John Santelli, and Sheila Desai, “Understanding the Decline in Adolescent Fertility in the United States, 2007-2012,” Journal of Adolescent Health 59, no. 2 (2016): 577-83.
  4. Yasamin Kusunoki et al., “Black-White Differences in Sex and Contraceptive Use Among Young Women,” Demography 53, no. 5 (2016): 1399-1428.
  5. Jennifer Barber et al., “The Relationship Context of Young Pregnancies,” Law & Inequality: A Journal of Theory and Practice 35, no. 2 (2017): 175-97.
  6. William J. Doherty, “Commentary: Jennifer Barber’s Landmark Research on the Connection Between Intimate Partner Violence and the Onset of Pregnancy,” Law & Inequality: A Journal of Theory and Practice 35, no. 2 (2017): 176-221.
  7. Leslie J. Harris, “Family Policy After the Fragile Families and Relationship Dynamics Studies,” Law & Inequality: A Journal of Theory and Practice 35, no. 2 (2017): 223-38.
  8. Yasamin Kusunoki et al., “Physical Intimate Partner Violence and Contraceptive Behaviors Among Young Women,” Journal of Women’s Health (Sept. 2017): DOI: 10.1089/jwh.2016.6246, accessed on Dec. 20, 2017.
  9. Sarah Hayford et al., “Perceived Costs and Benefits of Early Childbearing: New Dimensions and Predictive Power,” Perspectives on Sexual and Reproductive Health 48, no. 2 (2016): 83-91.
  10. Abigail Weitzman et al., “Desire for and to Avoid Pregnancy During the Transition to Adulthood,” Journal of Marriage and Family 79, no. 4 (2017): 1060-75.