The primary aim of the current review was to identify and evaluate the major themes emerging from qualitative studies exploring intended adolescent pregnancy. Six overarching themes emerged from the synthesis of the included studies: Desire and Closeness; Negative perceptions of pregnancy and “fears”; Benefits and positive aspects of pregnancy; Ambivalence and Fatalism; Others perceptions; Common characteristics of adolescents who become pregnant. The majority of the data collected in these studies express a sampling of young people’s views. In this respect, the review provides a synthesis of themes that represent the perspectives of adolescents’ themselves on the topic of intended adolescent pregnancy. The participants were adolescents of different reproductive status (pregnant, not pregnant, or parenting), and therefore the synthesis results combined accounts of young people’s views from several vantage points.
In terms of the predominant themes emerging from the synthesis, Desire and Closeness was prominent, reflecting the high frequency and salience within the articles of a rationalization of the desire to become pregnant or to “have a baby”. Items in this theme emphasized relational aspects of motherhood, in contrast with more practical aspects. The latter consideration was reflected in the theme Benefits and positive aspects of pregnancy.
Although it is estimated that the majority of teenage pregnancies are unintended and “the first conscious decision that many teenagers make about their pregnancy is whether to have an abortion or to continue with the pregnancy” (Social Exclusion Unit 1999, p. 28), the findings of the review show that for some adolescents a certain degree of decision-making occurs prior to conception. Despite the common belief that adolescent pregnancies are outcomes of inadequate sexual education and ignorance about contraception (Drife 2004), many participants described a coherent awareness of the connection between sexual intercourse and pregnancy, and clear intentions to conceive.
One possibility is that the desire theme reflects an attachment or relational perception of the baby as a contributor to the mother’s emotional wellbeing (Goldberg 2000). For instance, longing for love from parents, partner, or the future child, was a notable construct. Similarly, the need for stability in life and compensation for emotional neglect experienced from carers were frequently mentioned motives. It is noteworthy, however, that for some participants a desire to have a baby was not directly linked to being a parent as presented by one of Montgomery’s (2002) interviewees who wanted a baby around, but said that a younger sibling would have been equally satisfying.
The perceived drawbacks of pregnancy were grouped in the theme Negative perceptions of pregnancy and “fears”. Particularly relevant to the subject of the reviews the notion that some adolescents who became pregnant intentionally were disappointed with how reality did not meet their expectations. This post-birth construct juxtaposed with the striking optimism presented by some pregnant interviewees (e.g., Spear 2001) draws attention to the role of the possibility of having an idealized image of what life would be like after conception. It has been suggested that cognitive maturity plays a role in sexual and reproductive decision-making (Shearer et al. 2002) and, depending on an individual’s cognitive stage, the ability to accurately envisage the consequences of pregnancy may be limited (Gordon 1990). Sheeder et al. (2009) noted that adolescents are prone to define benefits and costs of parenting by the circumstances of their relationship with their partner rather than in consideration of life plans.
Perceived benefits of early childbearing were grouped in Benefits and positive aspects of pregnancy. Although a great part of the literature emphasizes the disadvantages of teenage parenthood (Coleman 2011), observations such as that pregnancy causes a favorable change in an adolescent’s life and is not an obstacle for vocational accomplishments are supported by some more recent studies (e.g., Ermish and Pevalin 2003). Zeck et al. (2007) examined long term outcomes of Austrian females who gave birth at the age of 17 or younger and found that within 5 years from delivery a significant part of mothers obtained higher level education and were more satisfied in certain aspects of life compared with a reference group. Such reports of young mothers’ subjective assessment indicate that the common belief that adolescent pregnancy generates hardship may not be true for all teenage mothers, although this may itself be subject to contextual considerations, such as cultural background.
In contrast to the unequivocal perceptions depicted above, the synthesis revealed a group of concepts expanding beyond a simplistic desire to become pregnant. Some statements indicated young people’s ambivalence toward pregnancy and a fatalistic vision of conception as an event being beyond their control. Such voices were grouped in the theme Ambivalence and Fatalism. In some cases the reason for failure to use contraception was an intention to conceive. However, for a percentage of participants there was no conscious intent to do so, and yet they deliberately neglected to use contraception. Equivocal viewpoints have also been observed in quantitative investigations of adolescents’ attitudes toward childbearing. Stevens-Simon et al. (1996) found that in a group of 200 pregnant teenagers 20 % said they did not use contraception because they “did not mind getting pregnant” (p. 48). Additionally, Jaccard et al. (2003) in their longitudinal study showed that between 15 and 30 % of participating teenagers presented “some degree of ambivalence toward becoming pregnant relative to their peers” (p. 79). Therefore, our themes and existing research suggest that there is a lack of coherence and contradiction within adolescent’s attitudes to intended pregnancy that fits with the position of adolescence as a developmental period where individuals demonstrate fluidity in their identity and beliefs.
Our synthesis also clarifies how much existing health education and/or folk beliefs regarding adolescent childbearing inform young people’s subjective understanding of intended pregnancy. General statements about teenage motherhood were distinguished from more specific observations regarding common characteristics of adolescent pregnant females. Views that went beyond participants’ personal experiences were grouped in the theme Others perceptions. For example, opinions such as that teenage pregnancy is a common and acceptable event, and that pregnancy does not significantly alter one’s life were placed in this theme. Such beliefs suggest that in some social contexts early childbearing may be a norm. We also note that the observation that “[t]he social networks of young people in their families and communities are significant sources of cultural beliefs and of social support” has significant implications (Jones 2005, p. 3). In communities where early parenting is acceptable and encouraged, ordinary attempts to reduce unintended pregnancy rates may prove unsuccessful.
Findings from qualitative research cannot be statistically representative of other populations (Horsburgh 2003), however, some of the Common characteristics of adolescents who become pregnant identified in the synthesis are consistent with findings from quantitative studies. For example, risk factors for teenage pregnancy identified by Dennison (2004) include experiencing deprivation, being a child of an adolescent mother, and low educational achievement. However, a USA longitudinal study that used pregnancy intentions as a variable showed that in terms of social milieu features (such as parental relationship status, household-social problems, and having a friend who experienced pregnancy) teenage pregnant females who wanted a baby did not differ from participants for whom pregnancy “just happened” (Rubin and East 1999). Further research should address these contradictory findings.
We acknowledge several limitations of the current review, both in terms of the implementation of the review and the limitations of the primary research. Firstly, with regard to the review methodology, there are several approaches to integrating qualitative research (e.g., meta-ethnography, grounded theory, case survey, narrative summary), and this review was naturally constrained by the limitations of the chosen method (Saini and Shlonsky 2012). The process of qualitative synthesis is inherently interpretive, therefore open to subjectivity and potential bias (Dixon-Woods et al. 2005). In this respect, we acknowledge the first author’s midwifery background and the second author’s training as Clinical Psychologist could have influenced their interpretation.
Secondly, we note limitations inherent to the reporting of the primary research included in the review. The quality of the review may have been constricted by the variability of the included studies. Methodological shortcomings of the included studies including lack of clarity regarding what constitutes a theme, and differences in reporting made it difficult to extract and synthesize data. These difficulties are common weaknesses in synthesizing findings from qualitative studies. (Sandelowski and Barroso 2002). Nevertheless, given the scarcity of eligible data in this emerging field, it may be justified to have broad inclusion criteria to accurately summarize the literature. It has, however, been noted that general standards regarding systematic synthesis of qualitative data are needed (Carroll et al. 2012).
1. UNFPA. Motherhood in childhood: Facing the challenge of adolescent pregnancy: The State of World Population 2013. New York: United Nations Population Fund; 2013. pp. 163–196.
2. World Health Organization. [Accessed January 27, 2014];Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. Available at: http://www.who.int/reproductivehealth/publications/adolescence/9789241502214/en/
3. National Research Council. Growing up global: The changing transitions to adulthood in developing countries. Washington, DC: The National Academies Press; 2005.
4. Coyne CA, D’Onofrio BM. Some (but not much) progress toward understanding teenage childbearing: A review of research from the past decade. Adv Child Dev Behav. 2012;42:113–152.[PMC free article][PubMed]
5. Korenman S, Fales S. The socioeconomic effects of teenage childbearing: A review of the recent literature. New York: Baruch College, City University of New York; 2011.
6. Kothari MT, Wang S, Head S, et al. Trends in adolescent reproductive and sexual behaviors. DHS Comparative Reports No. 29. Calverton, MD: ICF International; 2012.
7. Nove A, Matthews Z, Neal S, et al. Maternal mortality in adolescents compared with women of other ages: Evidence from 144 countries. The Lancet Glob Health. 2012;2:e155–e154.[PubMed]
8. Singh S, Darroch JE. Adolescent pregnancy and childbearing: Levels and trends in developed countries. Fam Plann Perspect. 2000;32:14–23.[PubMed]
9. Singh S. Adolescent childbearing in developing countries: A global review. Stud Fam Plann. 1998;29:117–136.[PubMed]
10. United Nations Statistics Division (UNSD) [Accessed January 16, 2014];2009–2010, 2011 demographic yearbook. 2008 Available at: http://unstats.un.org/unsd/demographic/products/dyb/dyb2011.htm. http://unstats.un.org/unsd/demographic/products/dyb/dyb2009-2010.htm. http://unstats.un.org/unsd/demographic/products/dyb/dyb2008.htm.
11. UNICEF. [Accessed September 1, 2013];The Transformative Monitoring for Enhanced Equity (Trans-MonEE) database. 2013 Available at: http://www.transmonee.org/
12. United Nations Population Division, Population estimates and projections section. [Accessed January 16, 2014];World population prospects: The 2012 revision. Available at: http://esa.un.org/unpd/wpp/index.htm.
13. Sedgh G, Singh S, Henshaw SK, et al. Legal abortion worldwide in 2008: Levels and recent trends. Int Persp Sex Reprod Health. 2011;37:84–94.[PubMed]
14. Jones RK, Jerman J. Abortion incidence and service availability in the United States, 2011. Perspect Sex Reprod Health. 2014;46:3–14.[PubMed]
15. Pazol K, Creanga AA, Burley KD, et al. Morbidity and Mortality Weekly Report. Division of Reproductive Health, CDC; 2010. [Accessed August, 15 2014]. Abortion Surveillance – United States. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6208a1.htm?s_cid=ss6208a1_w.
16. Sedgh G, Rossier C, Kaboré I, et al. Estimating abortion incidence in Burkina Faso using two methodologies. Stud Fam Plann. 2011;42:147–154.[PubMed]
17. Singh S, Fetters T, Gebreselassie H, et al. The estimated incidence of induced abortion in Ethiopia, 2008. Int Perspect Sex Reprod Health. 2010;36:16–25.[PubMed]
18. Levandowski BA, Mhango C, Kuchingale E, et al. The incidence of induced abortion in Malawi. Int Perspect Sex Reprod Health. 2013;39:88–96.[PubMed]
19. Juarez F, Singh S. Incidence of induced abortion by age and state, Mexico, 2009: New estimates using a modified methodology. Int Perspect Sex Reprod Health. 2012;38:58–67.[PubMed]
20. Mohamed SF, Izugbara C, Moore AM, et al. The incidence of induced abortion in Kenya. Manuscript submitted to the British Journal of Obstetrics and Gynaecology
21. Bongaarts J, Potter RG. Fertility, biology, and behavior: An analysis of the proximate determinants. New York: Academic Press; 1983.
22. Leridon H. Human fertility: The basic components. Chicago: University of Chicago Press; 1977.
23. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38:90–96.[PubMed]
24. United Nations Statistics Division. [Accessed August 1, 2014];Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. Available at: http://unstats.un.org/unsd/methods/m49/m49regin.htm.
25. Kost K, Henshaw S. U.S. teenage pregnancies, births and abortions, 2010: National and state trends by age, race and ethnicity. New York: Guttmacher Institute; 2014.
26. Wilkinson P, French R, Kane R, et al. Teenage conceptions, abortions, and births in England, 1994–2003, and the national teenage pregnancy strategy. Lancet. 2006;368:1879–1886.[PubMed]
27. Mckay A. Trends in Canadian national and provincial/territorial teen pregnancy rates: 2001–2010. Can J Hum Sex. 2012;21:161–175.
28. McKay A, Barrett M. Trends in teen pregnancy from 1996–2006: A comparison of Canada, Sweden, U.S.A. and England/Wales. Can J Hum Sex. 2010;19:43–52.
29. Biddlecom AE, Singh S, Bankole A, et al. Protecting the next generation in Sub-Saharan Africa: Learning from adolescents to prevent HIV and unintended pregnancy. New York: Guttmacher Institute; 2007.
30. Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. Am J Public Health. 2014;104(Suppl):S43–S48.[PMC free article][PubMed]
31. Santelli J, Sandfort T, Orr M. Transnational comparisons of adolescent contraceptive use: What can we learn from these comparisons? Arch Pediatr Adolesc Med. 2008;162:92–94.[PubMed]
32. Santelli JS, Melnikas AJ. Teen fertility in transition: Recent and historic trends in the United States. Annu Rev Public Health. 2010;31:371–383.[PubMed]
33. Santelli JS, Sharma V, Viner R. Inequality, national wealth, economic development and global trends in teenage birth rates, 1990–2010. J Adolesc Health. 2013;53:S4–S5.
34. Schalet A. Not under my roof: Parents, teens and the culture of sex. Chicago: The University of Chicago Press; 2011. http://dx.doi.org/10.1007/s10964-012-9851-y.
35. Part K, Moreau C, Donati S, et al. Teenage pregnancies in the European Union in the context of legislation and youth sexual and reproductive health services. Acta Obstet Gynecol Scand. 2013;92:1395–1406.[PubMed]
36. Humby P. An analysis of under 18 conceptions and their links to measures of deprivation, England and Wales, 2008–10. London: Office for National Statistics; 2013. [Accessed January 16, 2014]. Available at: http://www.ons.gov.uk/ons/dcp171766_299768.pdf.
37. Ventura SJ, Curtin SC, Abma JC, Henshaw SK. Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008. [Accessed August 2, 2014];Natl Vital Stat Rep. 2012 60:1–21. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_07.pdf. [PubMed]
38. Harden A, Brunton G, Fletcher A, et al. Teenage pregnancy and social disadvantage: Systematic review integrating controlled trials and qualitative studies. BMJ. 2009;339:b4254.[PMC free article][PubMed]
39. Narring F, Yaron M. Adolescent pregnancy in Switzerland. In: Cherry AL, Dillon ME, editors. International handbook of adolescent pregnancy. New York: Springer Science + Business Media; 2014. pp. 599–604.
40. UNFPA Eastern Europe and Central Asia Regional Office. Adolescent pregnancy in Eastern Europe and Central Asia. Istanbul, Turkey: United Nations Population Fund; 2013. [Accessed January 16, 2014]. Available at: http://eeca.unfpa.org/webdav/site/eeca/shared/documents/swop2013/Regional%20brief%20on%20teenage%20pregnancy.pdf.
41. ASTRA Network. Sexual and reproductive health and rights of adolescents in Central and Eastern Europe and Balkan countries. [Accessed August 4, 2014];ASTRA Youth report. 2011 Available at: http://www.astra.org.pl/pdf/publications/SRHRAY2011.pdf.