Repeat Pregnancy among Urban Adolescents: Sociodemographic, Family, and Health Factors
Coard, Stephanie Irby, Nitz, Katherine, Felice, Marianne E., Adolescence
First-time adolescent mothers are at high risk for a repeat pregnancy. The present investigation, part of an ongoing longitudinal study, examined sociodemographic, family, and health factors associated with repeat pregnancy in a clinic sample of urban, first-time adolescent mothers (ages 13 to 17 years). They were predominantly African-American and from low-income households. Repeat pregnancy within one year and between one and two years postpartum was determined from medical records. Summary statistics, point biserial correlations, and chi-square statistics were used to analyze the data. Results indicated that postpartum contraceptive method was associated with repeat pregnancy at Year 1; contraceptive use, maternal age, history of miscarriages, and postpartum contraceptive method were associated with repeat pregnancy at Year 2. It was concluded that efforts to prevent repeat pregnancies among first-time adolescent mothers should include the continuous monitoring of contraceptive use, as well as the promotio n of long-acting contraceptives (e.g., medroxyprogesterone or progesterone implants). Further, counseling should be offered to adolescent mothers with a history of miscarriages.
Adolescent pregnancy and childbearing continue to be common. The issues surrounding adolescent pregnancy and childbearing are politically controversial and emotionally charged. However, there is agreement regarding the serious repercussions for society.
The incidence of adolescent pregnancy and childbearing has been well-documented. Recently, there has been a downward trend in the adolescent birthrate. In 1995, the birthrate for females aged 15-19 in the United States was 56.9 per 1,000 (Moore, Romano, & Oakes, 1996); in 1996, it was 54.7 (Guyer, Martine, MacDorman, Anderson, & Strobino, 1997). Furthermore, between 1991 and 1995, the birthrate for African-American adolescents dropped 17%. Notable, however, is that approximately 30% to 35% of adolescent mothers have a repeat pregnancy within one year of the birth of the first child, and 40% to 50% have a repeat pregnancy within two years (National Research Council, 1987; Stevens-Simon & White, 1991). In 1996, 22% of all births to 15- to 19-year-olds were repeat births (National Center for Health Statistics, 1997).
The consequences of adolescent pregnancy and childbearing have also been well-documented (Furstenberg, 1976; Hofferth & Hayes, 1987; Maynard, 1996). For example, adolescent mothers are less likely to receive child support from biological fathers, less likely to complete their education or to work, and less likely to he able to provide for themselves and their children without outside assistance (Card & Wise, 1978; Furstenberg, 1976; Furstenberg, Brooks-Gunn, & Morgan, 1987; Maynard, 1996; Mott & Marsiglio, 1985).
While numerous interventions have been developed (e.g., abstinence education, clinic-based assistance, peer counseling programs), most are aimed at preventing pregnancy among adolescents who are not yet parents. Less attention has been focused on pregnancies among adolescents who are already mothers. Yet, data indicate that adolescents who become pregnant within two years of the birth of their first child may differ from those who do not. For example, adolescent mothers who experience a repeat pregnancy within two years often report that the pregnancy was a "planned affair" rather than an "accident" (Matsuhashi, Felice, Shragg, & Hollingsworth, 1989).
An ecological framework is useful for understanding factors associated with repeat pregnancy among young mothers. Ecological theory (Bronfenbrenner, 1979) emphasizes the interaction of individual characteristics and social systems. For instance, research indicates that factors prior to the first birth (e.g., adolescent mothers' race/ethnicity and their parents' education level) and those at the time of the first birth (e.g., years of education and whether the first birth was planned) are associated with the rapidity of the second birth (Kalmuss & Namerow, 1994). …