Adolescence is a transitional period characterized by opportunities for healthful development as well as risks for adverse health and social outcomes. It is now widely recognized that an adolescent's prospects for healthful development are influenced by myriad social, psychological, economic, and cultural factors (Kirby, 1999; Leffert et al., 1998; Resnick et al., 1997). Some of these (e.g., poverty, affiliation with peers who engage in high-risk behaviors, low self-esteem) appear to be risk factors for adverse health and social outcomes, while others (e.g., high parental educational expectations, "connectedness" with family and school, high self-efficacy) appear to be protective in that they tend to be associated with more favorable outcomes. Recent adolescent health research has assigned high priority to better understanding the relative importance of such factors so that youth programs might be developed to better reinforce the protective factors and mediate the risk factors that may be present in a given setting (Leffert et al., 1998; Resnick et al., 1997).
The present study was undertaken to address the question of why some female adolescents in La Paz, Bolivia, become pregnant while others in similar circumstances avoid early pregnancy. To investigate this question, the present study combined a nearest-neighbor case-control design with qualitative research methods (focus-group discussions). Study subjects for the case-control design consisted of matched pairs of female adolescents of the same age and residing in the same neighborhood, one of whom had experienced a pregnancy. Study subjects for the focus-group discussions were adolescent girls from the same population. The study focused on the following factors as possible explanations of the observed discordant outcomes: family structure, parental relationships, partner relationships, knowledge of pregnancy risk behaviors, self-esteem, and locus of control (internal versus external). The last three of these factors fall under the heading of what Kirby (1999) has termed "sexual psychosocial antecedents." Altho ugh our primary interest is in causal factors/antecedents of adolescent pregnancy, in many cases it is not possible to establish the direction of causality between factors and outcomes from the available data. For this reason, we use the term "correlates" instead of "antecedents."
Acquiring a better understanding of the correlates of pregnancy among Bolivian adolescents is important for several reasons. Bolivia, similar to many developing countries, has a very young population. Estimates from the 1998 Demographic and Health Survey indicate that 51% of the Bolivian population was 19 years of age or younger, including slightly over 10% between ages 15 and 19 (Republica de Bolivia, 1998). Most (63%) Bolivian females reach the secondary level of education, although by age twenty roughly 30% become pregnant (Republica de Bolivia, 1998). Recent estimates indicate a teen birth rate in Bolivia of 79 births per 1,000 females aged 15-19, well above the regional average (including North America) of 68 births (Republica de Bolivia, 1998; UNICEF, 1998). WHO/PAHO (1998) projections suggest that in the year 2000, 13% of all births in Bolivia will be to adolescents. Abortion in Bolivia is legal only if the health of the mother is in danger or in the case of rape, and thus voluntary termination of pre gnancies is not well documented and occurs under nonregulated conditions (Population Reference Bureau, 1994).
The target population for the study was females 13-19 years of age residing in a peri-urban area of La Paz--the First Health District, known as La Garita de Lima. The total population of this area is estimated to be 250,000. There are 14 primary health care centers in the First Health District, all of which were sites for data collection.
A combination of quantitative and qualitative methods was used in gathering data for the study. …