503

Concepts of the Advantages and Disadvantages of Teenage Childbearing Among
Pregnant Adolescents: A Qualitative Analysis

Cynthia Rosengard, Lealah Pollock, Sherry Weitzen, Ann Meers and Maureen G.
Phipps
Pediatrics 2006;118;503-510
DOI: 10.1542/peds.2005-3058
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://www.pediatrics.org/cgi/content/full/118/2/503
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ARTICLE
Concepts of the Advantages and Disadvantages of

Teenage Childbearing Among Pregnant Adolescents:
A Qualitative Analysis
Cynthia Rosengard, PhD, MPHa, Lealah Pollock, BAb, Sherry Weitzen, PhDb, Ann Meers, RNb, Maureen G. Phipps, MD, MPHb
aDivision of General Internal Medicine, Department of Medicine, Rhode Island Hospital, and bDepartments of Obstetrics and Gynecology and Community Health,
Women & Infants’ Hospital, Brown University School of Medicine, Providence, Rhode Island
The authors have indicated they have no financial relationships relevant to this article to disclose.
ABSTRACT
OBJECTIVE. We sought to enhance our understanding of pregnant adolescents’ con-
cepts of the advantages and disadvantages of teen pregnancy and childbearing.
www.pediatrics.org/cgi/doi/10.1542/
METHODOLOGY. This is a qualitative study of 247 pregnant adolescents recruited peds.2005-3058
during their first prenatal health care visit to a women’s primary care clinic in doi:10.1542/peds.2005-3058
Providence, Rhode Island. Participants responded in writing to open-ended ques- Key Words
teenage childbearing, attitudes, pregnant
tions assessing their ideas about what was advantageous and disadvantageous adolescents, qualitative analysis
about having an infant during their teen years rather than waiting until they were Accepted for publication Feb 6, 2006
older. Themes and patterns in responding were coded, and subgroup differences Address correspondence to Cynthia
based on age, ethnicity, intendedness of current pregnancy, and pregnancy/ Rosengard, PhD, MPH, Rhode Island Hospital,
DGIM, Multiphasic Building 1, 593 Eddy St,
parenting history were assessed. Providence, RI 02903. E-mail: crosengard@
lifespan.org
RESULTS. Themes related to advantages of teen pregnancy included enhancing con- PEDIATRICS (ISSN Numbers: Print, 0031-4005;
nections, positive changes/benefits, and practical considerations. Themes related Online, 1098-4275). Copyright © 2006 by the
American Academy of Pediatrics
to disadvantages included lack of preparedness, changes/interference, and others’
perceptions. Differences among groups based on age, ethnicity, intendedness of
the current pregnancy, and pregnancy/parenting history were examined and
noted.
CONCLUSIONS. Pregnant adolescents do not represent a homogeneous group. Consid-
ering differences in how pregnancy and childbearing are conceptualized along
developmental, cultural, attitudinal, and experiential lines will strengthen our
ability to tailor pregnancy-prevention messages.
PEDIATRICS Volume 118, Number 2, August 2006 503

A LTHOUGH TEEN PREGNANCY rates have dropped in
recent years, in 2000, more than 800 000 girls
under 20 years of age became pregnant in the United
enting and reduce the negative health consequences of
teenage childbearing in the United States.
To supplement the knowledge derived from quanti-
States, 478 000 of whom gave birth.1 Fifty-six percent of tative methods that have been applied to the question of
teen pregnancies result in live births, and 1 in 4 teenage adolescent attitudes toward pregnancy, we undertook
mothers have another child within 2 years.2–4 Overall, the current qualitative study to explore what pregnant
more than three quarters of teen pregnancies are con- adolescents view as the advantages and disadvantages
sidered unplanned or unintended, with more than a of having an infant during their teen years. Open-ended
third of all teen pregnancies ending in abortion.3 In questions were posed to pregnant adolescent girls who
addition, between 40% and 60% of births to teen moth- were attending their first prenatal health visit. They
ers are considered the result of unintended pregnan- were asked to provide written answers to questions
cies.2,3,5–7 regarding the advantages and disadvantages of having
In recent years there has been a strong emphasis on an infant at this time in their lives instead of waiting
developing and evaluating programs to prevent first and until later. Themes were identified and patterns were
subsequent pregnancies among adolescents. However, examined in responses that were associated with age
little work has focused on what teenagers believe about (12–15 years old, 16 –17 years old, and 18 –19 years old),
teen pregnancy. Understanding their concepts of the ethnicity (Hispanic versus non-Hispanic), intendedness
advantages and disadvantages of teen childbearing may of current pregnancy (intended versus unintended), and
point to ways in which pregnancy-prevention efforts can reproductive experience factors (previous pregnancy
be enhanced and tailored to subgroups of teenagers. versus no previous pregnancy and children versus no
Quantitative research on adolescents’ attitudes to- children).
ward pregnancy/parenthood suggests a number of
important antecedents, a continuum of negative-to- METHODS
positive attitudes, and several potential behavioral
outcomes. For example, Jaccard et al8 found that adoles- Participants and Recruitment
cent girls’ discussions with their mothers about the neg- A convenience sample of pregnant teens 19 years and
ative consequences of pregnancy, stronger maternal younger who presented for initial prenatal care in the
disapproval of teen pregnancy, and greater adolescent Women’s Primary Care Center at Women & Infants’
satisfaction with mother-daughter relationships were all Hospital was recruited between February 2002 and Au-
associated with more negative attitudes toward preg- gust 2004. Two hundred forty-seven pregnant adoles-
nancy among adolescent girls. Another recent study cent females (62% of eligible patients) were recruited
found that although a majority of nonpregnant adoles- successfully and consented for participation in our
cents reported consistently negative attitudes toward study. Nonparticipants could not be recruited or appro-
pregnancy (eg, “getting pregnant at this time in my life is priately consented because their parents were not avail-
one of the worst things that could happen to me”), there able to consent, because they had language/intellectual
was a sizable minority who reported ambivalent or even barriers that prevented successful completion of the
positive attitudes toward pregnancy. In this study, ado- consent form or survey, or because of research staffing
lescents’ ambivalent attitudes toward pregnancy were limitations. For those participants who were between
associated with becoming pregnant within 1 year.9 An- the ages of 12 and 17, inclusive parental consent was
other longitudinal study found variation in nonpregnant obtained before participation in the study. One quarter
adolescent girls’ pregnancy attitudes and an association of those informed about the study declined to par-
between pregnancy attitudes and intentions to become ticipate. The racial/ethnic and age composition of the
pregnant within the next 6 months. In this study, non- current sample does not differ significantly from the
pregnant adolescents’ pregnancy intentions predicted population of adolescents served at the Women’s Pri-
suspected pregnancies and positive pregnancy test re- mary Care Center at Women & Infants’ Hospital.
sults at 6-months’ follow-up.10
Understanding adolescents’ attitudes toward teen Procedures
pregnancy has significant clinical application. Adoles- As part of a larger study examining pregnant adolescent
cent pregnancies are often characterized by delayed ini- girls’ pregnancy intentions, participants were asked to
tiation of prenatal care, poor prenatal health behaviors, provide written answers to open-ended questions re-
and low birth weight infants.11–13 Recent work also sug- garding their attitudes and motivations about being
gests that even healthy infants born to teenage mothers pregnant. The larger study was initially approved by the
are at increased risk of postneonatal death.14 Clearly, Women & Infants’ Hospital Institutional Review Board
understanding adolescents’ attitudes toward and moti- in December 2001. During their first prenatal visit, a
vations for pregnancy may aid in efforts to educate ad- research nurse or trained research assistant interviewed
olescents regarding the realities of teen pregnancy/par- participants by using a structured questionnaire. The
504 ROSENGARD et al
questionnaire included items measuring demographics, coded per the resulting coding scheme. The software allows
pregnancy intentions, feelings/reactions about their for the organization and examination of coded responses
pregnancy, birth control use, decision-making process on the basis of different groupings of participants. The
regarding pregnancy, support system, living situation, coding group met regularly throughout the process to dis-
sexual experiences, school and extracurricular involve- cuss coding, modifying the coding scheme and maintaining
ment, reproductive health history, substance use behav- fidelity to coding scheme, until consensus was reached.
iors, and abuse history. After the interview was com- Group-level differences in themes and patterns were iden-
pleted, participants were asked to fill out the 1-page tified and reported here.
open-ended questionnaire.
RESULTS
Measures
Participants
Demographics Two hundred forty-seven pregnant adolescent girls (mean
Participants were asked their age, ethnicity (Hispanic or age: 16.8 years; SD: 1.5; range: 12–19 years) responded to
non-Hispanic), and race. open-ended questions regarding the advantages/disadvan-
tages of being pregnant now instead of when they are
Pregnancy Intention and Reproductive History older. Participants fell into the following age categories: 48
Participants were asked to answer the question, “Think (19.4%) were 12 to 15 years old, 94 (38.1%) were 16 to 17
back to the time just before you found out you were years old, and 105 (42.5%) were 18 to 19 years old. Ap-
pregnant, and how you felt about pregnancy at that proximately half (117 [47.3%]) indicated that they were
time. When did you want to be pregnant?” Participants Hispanic. The racial background of the non-Hispanic par-
who indicated “Immediately (now),” “In the next few ticipants included 19.4% white, 17.8% black, 4.5% Asian,
months,” or “In the next year” were characterized as 4% American Indian/Alaskan Native, and 17.9% other.
having “intended” the current pregnancy. Those who Fifty-eight girls (23.5%) indicated that their current preg-
indicated “More than a year from now” or “I did not nancy was intended (by indicating that they wanted to be
want to get pregnant” were characterized as having “un- pregnant immediately, within the next few months, or
intended current pregnancies.” Participants were also within the next year), and 189 (76.5%) indicated that it
asked to indicate (1) if they have ever been pregnant was unintended. Seventy-three girls (29.8%) reported at
before and (2) how many children they have. Those least 1 previous pregnancy, and of those, 36 (14.7% of the
who indicated they had been pregnant previously were total sample and 49.3% of those with a previous preg-
also asked if they had ever had an abortion and/or ever nancy) indicated that they already had at least 1 child. Of
had a miscarriage (separate questions). those 73 who reported a previous pregnancy, 18 (24.7%)
reported a previous abortion, and 31 (42.5%) reported a
Advantages/Disadvantages of Teen Pregnancy previous miscarriage.
The qualitative aspect of the study involved open-ended
questions to which participants were asked to write Teen Pregnancy Advantages
down their answers. The questions appeared in the same The main themes found in the responses to the question
order for all participants: regarding advantages include denial of any advantages;
connections; benefits and positive changes; and practical
1. Considering everything, what do you think are the considerations related to their being young and concerns
bad things or disadvantages about having a baby now about the future. The upper half of Table 1 summarizes
instead of waiting until you are older? the advantage themes, subthemes, and dimensions.
2. What do you think are the good things or advantages
about having a baby now instead of waiting until you No Advantages Noted
are older? Participants who were unable to identify advantages to
teen pregnancy/childbearing voiced some powerful mes-
Coding and Analysis sages:
In the first round of qualitative analysis, responses “I don’t know of any good things or advantages of having
were organized15 by a research assistant, and preliminary a baby this young” (17-year-old, non-Hispanic, unin-
codes were generated on the basis of occurrence of themes tended pregnancy, no previous pregnancy).
or identification of patterns in the responses. In the second “I don’t think there are any. I feel teens should wait”
round of qualitative analyses, the study’s principal investi- (17-year-old, non-Hispanic, unintended pregnancy, pre-
gator (M.G.P.) and coinvestigator (C.R.) reviewed all data, vious pregnancy, 1 child).
generating additional codes to represent both a priori and “there is no advantages I can think about right now”
emergent themes. Data were entered into NVIVO 6.0 soft- (19-year-old, Hispanic, unintended pregnancy, no pre-
ware (QSR International Pty Ltd, Victoria, Australia) and vious pregnancy).

TABLE 1 Identified Themes, Subthemes, and Dimensions Within “being able to play along with your child not only being
Advantages and Disadvantages of Teen his/her parent but being a friend” (13-year-old, non-His-
panic, unintended pregnancy, no previous pregnancy).
Pregnancy/Parenting Among 247 Pregnant Adolescents
Theme Subtheme Dimension “The good things are I no [sic] I have way more support.
If I were older I’d be expexted [sic] to take way more
Advantages
responsibility” (18-year-old, non-Hispanic, unintended
No advantages noted No advantages
pregnancy, no previous pregnancy).
Same as pregnancy later
Connections Love of babies I love babies
Benefits/Positive Changes
Excitement about babies
Relationships Someone to love Girls who focused on the positive changes that they
Someone to love me associate with having an infant during their teens, rather
Possessing something than waiting until later, commented on how it would
Attachment to someone else require them to grow up and take more responsibility in
Closeness Close in age with baby
their lives, as well as the benefits of being a young
Company for me or sibling
Support Family support mother and growing up along with their child and pro-
Partner support viding themselves with purpose for their lives. Examples
Benefits/positive changes Growth/purpose More responsibilities of these sentiments include:
Growing up
Purpose in life “I will have more responsibilities in my life. I will have to
Positive Everything is positive be more mature” (14-year-old, non-Hispanic, unin-
Happiness about situation tended pregnancy, no previous pregnancy).
Acceptance of situation “I think that it will keep me away from doing bad
Practical considerations Youth Young and energetic things like drinking alcohol and/or doing drugs. It will
Future fertility concerns make me be more responsible and I’ll learn how to
Timing Time later in life depend on myself more” (18-year-old, non-Hispanic,
Getting pregnancy over with unintended pregnancy, no previous pregnancy).
Disadvantages
No disadvantages noted No disadvantages “the good thinks [sic] are that I have someone to live for”
Same as pregnancy later (15-year-old, Hispanic, unintended pregnancy, no pre-
I feel ready vious pregnancy).
Lack of/insufficient Too young Immature “theres [sic] not 2 [sic] many good things. Except now
preparedness Emotionally unprepared
Im [sic] gonna have a huge responsibility and have to
Lack of stability Financial instability
love and care for something. [T]o me thats [sic] a good
Employment instability
thing” (15-year-old, non-Hispanic, unintended preg-
Lack of stable housing
Relationship uncertainty
nancy, no previous pregnancy).
Changes/interference Interference Alteration in plans
Practical Considerations
Life is more difficult
Missing out on teen years Pregnant teens whose responses emphasized the theme of
Changes More responsibility practical considerations focused on the advantages of being
Changes in appearance young and how the timing would be beneficial for them in
Others’ perceptions Shame their futures. Some also mentioned concerns about their
Seen differently by others
future fertility. Quotes that reflect this theme include:
“[S]till look young when I’m 25—you figured it out—the
baby will be going on 10” (15-year-old, non-Hispanic,
Connections unintended pregnancy, no previous pregnancy).
Those who indicated the positive impact on building a “[A]lso if I have a infant now later on when I want to
family and enhancing relationships because of having an become a lawyer my baby will be old enough” (15 non-
Hispanic, unintended pregnancy, no previous preg-
infant now instead of waiting until they were older
nancy).
focused on their love of infants; possessing something;
“The good things are that there are some people that
having someone to love and be loved by; benefits related
can’t have a child because of something they have and
to being closer in age with their child; and having more I’m happy for that case [sic] I can have a child” (18-year-
family/partner support at this time in their lives. Quotes old, Hispanic, unintended pregnancy, no previous preg-
that reflect this theme include: nancy).
“[G]onna get your own family and stuff like that” (12-year-
old, Hispanic, intended pregnancy, no previous preg- Teen Pregnancy Disadvantages
nancy). The main themes found in the responses to the question
“An advantage is that I feel a baby will make me and my regarding disadvantages included denial of any disad-
boyfriends relationship closer” (14-year-old, Hispanic, vantages; a sense of not being ready; reflections of how
unintended pregnancy, no previous pregnancy). having an infant will change things and interfere with
506 ROSENGARD et al
important aspects of their lives; and how being pregnant “The disadvantages of having a baby now instead of until I
as teenagers will change the way that others see them. get older are the things I can’t do anymore. I won’t have free
time for myself or friends. I have to stay home and take care of
The lower half of Table 1 summarizes the disadvantage my baby. It’s going to be hard to focus on school” (18-year-old,
themes, subthemes, and dimensions. non-Hispanic, unintended pregnancy, no previous preg-
nancy).
“[N]ot being able to go out and do normal teenage things
No Disadvantages Noted and not being able to do what i want when i want to” (13-
Many pregnant teens were unable to generate disadvan- year-old, non-Hispanic, unintended pregnancy, no previous
tages to being a teen mother or felt that having a child as pregnancy).
a teenager was no different from waiting until they were
older. Quotations that reflect this include: Others’ Views
There were also teens who mentioned the negative ef-
“I dont [sic] regret that about having a baby. I dont [sic] fects of how others might view them because they had
think is nothing rong [sic] with it” (14-year-old, Hispanic,
unintended pregnancy, previous pregnancy, no children). an infant during their teen years instead of waiting until
“I don’t really think there are any disadvantages in having they were older. Examples of these sentiments are:
a baby now, I am completely ready for this responsibility” “Sometimes I feel like I should be ashamed of myself for
(17-year-old, non-Hispanic, intended pregnancy, previous having a baby at such a young age. Or I feel like if other people
pregnancy, no children). say things when they see me. It sometimes puts me down
“I have no bad thoughts on having a baby now instead of because I start to wish that I should’ve done something differ-
waiting the only difference is I’m 17” (17-year-old, Hispanic, ent” (16-year-old, Hispanic, unintended pregnancy, previous
intended pregnancy, previous pregnancy, no children). pregnancy, one child).
“The things are that people might look at me differently and
Lack of Preparedness I have to change my whole lifestyle” (13-year-old, non-His-
panic, unintended pregnancy, no previous pregnancy).
Those adolescent girls who indicated lack of prepared-
ness as a disadvantage emphasized different areas in Identification of Themes Among/Between Different
which they were not ready, including being too young Subgroups
and lacking stability. Excerpts that illustrate this include:
Age
“I feel as though Im to [sic] young and im [sic] scared of
being alone taking care of a baby on my own. I feel as if I was
Examining the themes that were identified by partici-
older I would know of what was going to happen more” pants from different age groups (12–15, 16 –17, and
(17-year-old, non-Hispanic, unintended pregnancy, no previ- 18 –19 years) demonstrates the differences in how, at
ous pregnancy).
different developmental stages, pregnancy is viewed (see
“1. No job to support me and my baby[.] 2. Im [sic] not out Table 2). Teen pregnancy was seen as enhancing con-
of school” (14-year-old, non-Hispanic, unintended pregnancy,
no previous pregnancy). nections with others more often by those in the younger
age groups (12–15 and 16 –17 years), whereas practical
“[F]inancial problems. Not waiting until I was married be-
cause I’m not sure if the father is always gonna be there” considerations associated with teen motherhood were
(17-year-old, non-Hispanic, unintended pregnancy, no previ- most often identified by the oldest teens (18 –19 years).
ous pregnancy).
Both of these variables seemed to have an age-graded
“[N]ot having more life experience or education. Not fully continuum. With respect to the disadvantages identified,
having my life together before trying to raise another life”
(19-year-old, non-Hispanic, unintended pregnancy, no previ- it seems as though older teens are more able to recognize
ous pregnancy). (or acknowledge) their lack of preparedness but less
Changes/Interferences
Those who emphasized the interference and changes
TABLE 2 Differences in Themes Identified According to Age Groups
that result from teen pregnancy as disadvantages fo-
(12–15, 16 –17, and 18 –19 Years Old) Among 247
cused on how the experience would require them to put
Pregnant Adolescents
their lives on hold, revise their life goals, make their
daily lives more difficult/challenging, and make them 12–15 y 16–17 y 18–19 y
(N ⫽ 48), (N ⫽ 94), (N ⫽ 105),
miss out on important teenage experiences. The changes n (%) n (%) n (%)
that were emphasized included physical changes and the
Advantages
requirement of taking on additional responsibilities. Ex- No advantages noted 4 (8.3) 5 (5.3) 1 (⬍0.1)
cerpts that illustrate this theme are: Connections 27 (56.3) 44 (46.8) 39 (37.1)
Benefits/positive changes 15 (31.3) 35 (37.2) 41 (39)
“[W]hen I have to wake up in the middle of the night on
school days to take care of my babies [sic] cry” (14-year-old, Practical considerations 12 (25) 34 (36.2) 42 (40)
Hispanic, unintended pregnancy, no previous pregnancy). Disadvantages
No disadvantages noted 8 (16.7) 15 (16) 14 (13.3)
“[Y]ou can’t work because your [sic] pregnant. You have to Lack of preparedness 17 (35.4) 40 (42.6) 53 (50.5)
be out of school while you have your [b]aby. You also might
Changes/interference 40 (83.3) 62 (66.4) 67 (63.8)
have to drop out” (16-year-old, Hispanic, unintended preg-
nancy, no previous pregnancy). Others’ perceptions 3 (6.3) 2 (2.1) 1 (⬍0.1)

likely than the youngest teens to emphasize changes and TABLE 4 Differences in Identified Dimensions According to
interference with life goals. Pregnancy Intendedness of Current Pregnancy (Intended
Versus Unintended) Among 247 Pregnant Adolescents
Ethnicity Intended Unintended
Comparing Hispanic to non-Hispanic participants, there (N ⫽ 58), (N ⫽ 189),
seemed to be a greater emphasis placed on enhancing n (%) n (%)
connections with others as an advantage identified by Advantages
Hispanic participants (see Table 3). For both ethnic No advantages noted 1 (1.7) 9 (4.8)
Connections 38 (65.5) 90 (47.6)
groups, connection was noted with the highest frequen-
Benefits/positive changes 26 (44.8) 61 (32.3)
cy; for Hispanic participants, it stood alone, whereas for Practical considerations 24 (41.4) 46 (24.3)
non-Hispanic participants, connection and practical con- Disadvantages
siderations were emphasized more equally. Change/in- No disadvantages noted 16 (27.6) 24 (12.7)
terference was noted with similar frequency by the 2 Lack of preparedness 23 (39.7) 83 (43.9)
Changes/interference 35 (60.3) 108 (57.1)
ethnicity groups, but non-Hispanic teens were more
Others’ perceptions 0 6 (3.2)
likely to identify lack of preparedness as a disadvantage
to having a child when a teenager, compared with His-
panic teen mothers-to-be. TABLE 5 Differences in Identified Dimensions According to
Whether Participants Report Previous Pregnancy Among
Intendedness of Current Pregnancy 247 Pregnant Adolescents
In considering the differences in themes identified by Previous Pregnancy No Previous Pregnancy
those who intended their current pregnancies compared (N ⫽ 73), (N ⫽ 174),
with those who did not intend to be pregnant, some n (%) n (%)
interesting differences emerge (see Table 4). For exam- Advantages
ple, connections, benefits/positive changes, and practical No advantages noted 3 (4.1) 8 (4.7)
considerations are all identified more frequently as ad- Connections 40 (54.8) 74 (43)
Benefits/positive changes 31 (42.5) 65 (37.8)
vantages of teen pregnancy among those who intended Practical considerations 31 (42.5) 66 (38.4)
their pregnancy compared with those who indicated an Uncertain about advantages 3 (4.1) 13 (7.6)
unintended pregnancy. Those who intended the current Disadvantages
pregnancy are more than twice as likely to indicate no No disadvantages noted 17 (23.3) 24 (14)
disadvantages to teen pregnancies and are slightly less Lack of preparedness 38 (52.1) 85 (49.4)
likely to identify lack of preparedness as a disadvantage Others’ perceptions 2 (2.7) 5 (2.9)
to having a child during their teen years versus waiting Uncertain about disadvantages 0 5 (2.9)
until they are older.
Reproductive and Parenting History
Those who reported a previous pregnancy were slightly of teen pregnancy than those for whom this pregnancy
more likely to identify the advantage associated with the was their first (see Table 5). It is interesting to note that
enhancing-connections-with-others theme, more likely among those participants who already had at least 1
to indicate no disadvantages to teen pregnancy, and less child, the advantage identified most was how teen preg-
likely to identify changes/interference as disadvantages nancy enhances connections with others, and the disad-
vantage identified most was the changes/interference
that teen pregnancy causes (see Table 6).
TABLE 3 Differences in Identified Themes on the Basis of Ethnic
Group (Hispanic Versus Non-Hispanic) Among 247
DISCUSSION
Pregnant Adolescents
Examining these qualitative data provides a greater un-
derstanding of how pregnant adolescents view the po-
Hispanic Non-Hispanic
(N ⫽ 117), (N ⫽ 130), tentially good and bad effects of having children during
n (%) n (%) their teen years instead of waiting until they are older.
Advantages Both practical and personal advantages and disadvan-
No advantages noted 7 (6) 3 (2.3) tages were emphasized in the themes generated by the
Connections 64 (54.7) 62 (47.7) pregnant adolescents in our sample. Of note was the fact
Benefits/positive changes 44 (38.6) 58 (44.6) that changes were seen in both positive and negative
Practical considerations 47 (40.2) 62 (47.7)
Disadvantages
lights: as an advantage, in terms of requiring them to
No disadvantages noted 22 (18.8) 15 (11.5) acquire maturity and keeping them from engaging in
Lack of preparedness 51 (43.6) 83 (63.8) risky/unwise behaviors, and as a disadvantage, in terms
Changes/interference 98 (83.8) 97 (74.6) of the number of changes and challenges that they
Others’ perceptions 2 (1.7) 4 (3.1) would face.
508 ROSENGARD et al
TABLE 6 Differences in Identified Dimensions According to been uniform across racial and ethnic lines. From 1991
Whether Participants Report Previous Children Among to 2002, birth rates among non-Hispanic white, Ameri-
247 Pregnant Adolescents can Indian, and Asian/Pacific Islander adolescents, 15 to
Previous Child(ren) No Previous Child 19 years old, declined 33% to 36%. Among non-His-
(N ⫽ 36), (N ⫽ 211), panic black teenagers (15–19 years), pregnancy rates
n (%) n (%) have plummeted by more than half. In contrast, the
Advantages birth rate among Hispanic adolescents declined only
No advantages noted 2 (5.5) 9 (4.3) 20%.16 To develop effective sexual-health and pregnan-
Connections 24 (66.7) 96 (45.9)
cy-prevention programs, we need to understand the
Benefits/positive changes 11 (30.6) 71 (34)
Practical considerations 16 (44.4) 78 (37.3) possible reasons behind this differential decline. Our
Uncertain about advantages 1 (2.8) 14 (6.7) data suggest potential targets for intervention. For ex-
Disadvantages ample, including ideas for enhancing relationships with
No disadvantages noted 6 (16.7) 33 (15.8) others, capitalizing on lower expectations for positive
Lack of preparedness 17 (47.2) 102 (48.8)
changes and benefits, and enhancing realistic assess-
Others’ perceptions 2 (5.5) 5 (2.4) ments of preparedness may enhance current strategies
Uncertain about disadvantages 0 5 (2.4) used for preventing pregnancies and/or preparing for
healthy pregnancies and infants among Hispanic teens.
Perhaps the most interesting differences in the
It is particularly noteworthy that participants were themes identified came in comparing those teenagers
able to generate more disadvantages than advantages. who reported that they intended the current pregnancy
Disadvantage themes were almost always emphasized by compared with those who reported that the current
larger percentages of the sample than advantage themes. pregnancy was unintended. Enhancing connections,
Advantage themes were often unrealistic and sounded benefits/positive changes, and practical considerations
as though participants were striving to support their were all more likely to have been noted by those with
decisions to keep the pregnancy. Alternatively, society intended pregnancies. Even more striking were the
provides far more negative messages regarding adoles- number (almost one third) of those who intended their
cent pregnancy, thus making disadvantages more salient pregnancy who indicated no disadvantages to teen
to these teenagers. They may not be used to thinking pregnancy and childbearing. Although it is difficult to
about what is positive or good (ie, an advantage) about measure pregnancy intentions after an individual has
their pregnancy. already become pregnant, the 58 participants who indi-
It is clear from these data that pregnant adolescents cated that they desired a pregnancy immediately, within
are not a unitary or homogeneous group with respect to the next few months, or within a year certainly seem to
their views on teen childbearing. Differences in themes view teen pregnancy differently, particularly the ad-
identified by girls at different ages, from different ethnic vantages.
backgrounds, and with different ideas about the intend- Finally, it was instructive to examine the manner
edness of their current pregnancies demonstrate the in which teen pregnancy/childbearing was viewed by
varying potential intervention targets on the continuum those with previous pregnancy experience and by
of pregnancy prevention, prenatal and postpartum care those who already had children. The differences identi-
needs, evidenced within these different groupings. fied here may help us to identify ways of reducing repeat
Our descriptive analyses of the larger data set re- pregnancy and childbearing in adolescents. Again, with
vealed significant demographic, health-characteristics, both groups, it is important to discuss the perception that
and contraceptive-choice differences between pregnant teen pregnancy/childbearing enhances connections/
teens within the age groups of 12 to 15, 16 to 17, and 18 relationships with others and assist these teens to iden-
to 19 years (M.G.P., C.R., S.W., A.M., L.P., and Z. Bill- tify other means of connecting with others in their lives.
inkoff, unpublished data, 2006). Not surprisingly, the It is also important to capitalize on their identification
advantages/disadvantages of teen pregnancy and child- of change/interference as disadvantages of adolescent
bearing also differed among these groups, which may pregnancy and childbearing in assisting them to protect
guide intervention strategies appropriate for each group. themselves from subsequent pregnancies, if that is con-
For example, perhaps assisting the youngest teenagers in sistent with their desires.
identifying other ways of enhancing their connections Our study is not without limitations. Ours was a
with others as well as helping them to realistically assess convenience sample of pregnant adolescents who were
their preparedness for motherhood and capitalizing on attending their first prenatal visit; therefore, we are not
their concerns about how parenthood might require able to generalize our findings to nonpregnant teens or
major changes and interfere with important goals might pregnant teens who decided not to continue their preg-
help in preventing pregnancy. nancy, who did not seek prenatal care at all, or who
The recent decline in teenage childbearing has not sought care elsewhere. However, qualitative research

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510 ROSENGARD et al
Concepts of the Advantages and Disadvantages of Teenage Childbearing Among
Pregnant Adolescents: A Qualitative Analysis
Cynthia Rosengard, Lealah Pollock, Sherry Weitzen, Ann Meers and Maureen G.
Phipps
Pediatrics 2006;118;503-510
DOI: 10.1542/peds.2005-3058
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