Definitions

Adolescents are defined by the World Health Organization (WHO) as young people aged from 10 to 19 years , that is, it includes 3 years before entry into the teen years. Conceptions at ages under 14 are rare. It should be noted that 18- and 19-year-olds have reached the age of majority and are no longer children; they may hold a commercial pilot’s licence, be appointed as a police officer or become a Member of Parliament. The terms adolescents and teenagers will be used interchangeably in this article.

Much of the literature on repeat pregnancy in adolescence refers to the term rapid repeat pregnancy, which is defined as a subsequent pregnancy within 12–24 months of a previous pregnancy. This term is used with respect to adolescents who give birth, rather than those who have abortions. This review focusses mainly on conceptions leading to births.

Introduction

Most teenage women are biologically mature and often look like adults long before they reach mental maturity. This creates the dilemma of how much their reproductive behaviour should be determined by their autonomy and how much adult guardians and professionals should attempt to modify it.

Societal attitudes towards teenage pregnancy and motherhood are negative in many countries. However, these negative attitudes are not necessarily shared by all ethnic groups living in that country, in particular by those in society living in poverty , the exact social group that are being targeted by public health interventions. This gives rise to the possibility that attempts to change reproductive behaviour could be interpreted as coercive.

National policy concern about teenage pregnancy varies from no concern to major concern; this is not necessarily related to high or low teenage fertility. Countries such as France and Spain with low rates express major concern. Countries such as Iceland and the Slovak Republic with rates nearly as high as those in the UK express no concern.

As many as 15 million adolescent girls give birth and 4 million have abortions each year. Worldwide, most adolescent pregnancies are in countries with a high rate of child marriage. In some cultures and ethnic groups, early childbearing is the social norm. Consideration needs to be given as to whether early marriage and childbearing violate an individual’s reproductive rights. Children (age under 18) have the right to privacy. Adults have the right to marry and found a family. Professionals have a duty to protect children from exploitation. These conflicting factors must be taken together so that the overall best interests of the child are promoted, taking into account the individual teenager’s competence and circumstances.

It should not be forgotten that a proportion of teenage childbearing takes place in some countries because of restrictive abortion laws. In countries in which teenagers have a free choice, as many as 81% of conceptions end in abortion (see section on Conceptions ).

Antecedents to adolescent pregnancy have a strong socioeconomic flavour. In the United States, with the highest rate of teenage births among industrialised nations, 40 million people live in poverty. In the United Kingdom, with the highest rate of teenage births in Western Europe, 13 million people live in households on a low income. Teenage pregnancy is strongly associated with social disadvantage. This includes unemployment, poverty and discrimination. However, clearly, this is not the whole story, as there are many less affluent countries in the Western world that do not have such high teenage fertility.

Young women who have grown up unhappy, in poor material circumstances, who do not enjoy school and are despondent about their future may be more likely to take risks when having sex or to choose to have a baby. Teenage mothers are often socially isolated. Adolescence is often described in the psychological literature as a time of ‘crisis’; motherhood at the same time can create an even greater crisis. Some teenage mothers may feel they have limited educational and occupational options, and so they do not see early motherhood as problematic. Some teenagers have a positive desire to become pregnant. More than a third of teenager mothers intend to become pregnant, either for the first time or when having subsequent rapid repeat pregnancies. Other teenagers experience ambivalence about becoming pregnant. Unintended pregnancies may be viewed as a form of escapism, representing temporary hopes in the minds of teenagers for positive change in their lives.

An adolescent who has had one unintended pregnancy is vulnerable to subsequent unwanted pregnancies. Studies in Latin America showed that younger adolescent mothers have a shorter birth interval and more subsequent births than older adolescent mothers. Early childbearing tends to perpetuate a cycle of poverty.

Teenage mothers who manage an inter-pregnancy interval of 2 years tend to avoid many of the negative consequences of early childbearing that often lead to chronic poverty and welfare dependence.