Magazine article Clinical Psychiatry News

Many Issues Converge in Teenage Pregnancy. (beyond Abstinence Promotion)

Magazine article Clinical Psychiatry News

Many Issues Converge in Teenage Pregnancy. (beyond Abstinence Promotion)

Article excerpt

NEW YORK -- A grasp of the psychological matrix of teenage pregnancy is essential in addressing the continuing problem. Prevention efforts should include compassionate support as well as broader sex education, Dr. Marilyn Benoit said at the annual meeting of the American Society for Adolescent Psychiatry.

Although the rate of teenage pregnancy declined in the 1990s by 18%, from a peak of 116.5 per 100,000 in 1991 to 98.7 per 100,000 in 1996, nearly 1 million American adolescents still become pregnant yearly.

This remains significantly higher, proportionally, than in any other industrialized country--twice the rate of England or Canada, and eight times Japan's rate--which could reflect a specifically American tension between religious and "liberal" values that encourages sexual behavior while inhibiting the use of effective contraception, said Dr. Benoit, president of the American Academy of Child and Adolescent Psychiatry.

For the most part, sex education in America rarely goes beyond promoting abstinence. Eight-six percent of public schools teach abstinence as a matter of policy, and 35% require it to be presented as the only option for preventing pregnancy prohibiting any discussion of contraception or focusing on its shortcomings. Just 14% of public schools have programs that discuss a range of contraception options, Dr. Benoit said.

The efficacy of abstinence education in preventing pregnancy is unproven, she noted.

Environmental factors clearly play a role in teen pregnancy Rates are robustly associated with socioeconomic level, which largely accounts for ethnic and racial differences. In some poorer communities, teen motherhood enhances status, while middle class girls who get pregnant are more likely to have the pregnancy terminated than are less affluent girls.

But the psychological substrate of teen pregnancy must also be understood. The impulsivity and poor judgment that seems endemic among adolescents (and is apparently rooted in the immature status of the frontal lobe) clearly puts them at risk. The emotional push-pull of the developmental stage, in which the desire to be independent and adult-like wars with a reluctance to relinquish childhood dependence, may be enacted in sexual behavior.

Individual psychological factors are frequently important. Conflicted feelings about the expression of sexuality can result in ambivalence toward using contraception, which would mean acknowledging one's sexual activity, Dr. …

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