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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publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
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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

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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
States, 478 000 of whom gave birth.1 Fifty-six percent of
teen pregnancies result in live births, and 1 in 4 teenage
mothers have another child within 2 years.2–4 Overall,
more than three quarters of teen pregnancies are con-
sidered unplanned or unintended, with more than a
third of all teen pregnancies ending in abortion.3 In
addition, between 40% and 60% of births to teen moth-
ers are considered the result of unintended pregnan-
cies.2,3,5–7
In recent years there has been a strong emphasis on
developing and evaluating programs to prevent first and
subsequent pregnancies among adolescents. However,
little work has focused on what teenagers believe about
teen pregnancy. Understanding their concepts of the
advantages and disadvantages of teen childbearing may
point to ways in which pregnancy-prevention efforts can
be enhanced and tailored to subgroups of teenagers.
Quantitative research on adolescents’ attitudes to-
ward pregnancy/parenthood suggests a number of
important antecedents, a continuum of negative-to-
positive attitudes, and several potential behavioral
outcomes. For example, Jaccard et al8 found that adoles-
cent girls’ discussions with their mothers about the neg-
ative consequences of pregnancy, stronger maternal
disapproval of teen pregnancy, and greater adolescent
satisfaction with mother-daughter relationships were all
associated with more negative attitudes toward preg-
nancy among adolescent girls. Another recent study
found that although a majority of nonpregnant adoles-
cents reported consistently negative attitudes toward
pregnancy (eg, “getting pregnant at this time in my life is
one of the worst things that could happen to me”), there
was a sizable minority who reported ambivalent or even
positive attitudes toward pregnancy. In this study, ado-
lescents’ ambivalent attitudes toward pregnancy were
associated with becoming pregnant within 1 year.9 An-
other longitudinal study found variation in nonpregnant
adolescent girls’ pregnancy attitudes and an association
between pregnancy attitudes and intentions to become
pregnant within the next 6 months. In this study, non-
pregnant adolescents’ pregnancy intentions predicted
suspected pregnancies and positive pregnancy test re-
sults at 6-months’ follow-up.10
Understanding adolescents’ attitudes toward teen
pregnancy has significant clinical application. Adoles-
cent pregnancies are often characterized by delayed ini-
tiation of prenatal care, poor prenatal health behaviors,
and low birth weight infants.11–13 Recent work also sug-
gests that even healthy infants born to teenage mothers
are at increased risk of postneonatal death.14 Clearly,
understanding adolescents’ attitudes toward and moti-
vations for pregnancy may aid in efforts to educate ad-
olescents regarding the realities of teen pregnancy/par-
504 ROSENGARD et al
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enting and reduce the negative health consequences of
teenage childbearing in the United States.
To supplement the knowledge derived from quanti-
tative methods that have been applied to the question of
adolescent attitudes toward pregnancy, we undertook
the current qualitative study to explore what pregnant
adolescents view as the advantages and disadvantages
of having an infant during their teen years. Open-ended
questions were posed to pregnant adolescent girls who
were attending their first prenatal health visit. They
were asked to provide written answers to questions
regarding the advantages and disadvantages of having
an infant at this time in their lives instead of waiting
until later. Themes were identified and patterns were
examined in responses that were associated with age
(12–15 years old, 16 –17 years old, and 18 –19 years old),
ethnicity (Hispanic versus non-Hispanic), intendedness
of current pregnancy (intended versus unintended), and
reproductive experience factors (previous pregnancy
versus no previous pregnancy and children versus no
children).
METHODS
Participants and Recruitment
A convenience sample of pregnant teens 19 years and
younger who presented for initial prenatal care in the
Women’s Primary Care Center at Women & Infants’
Hospital was recruited between February 2002 and Au-
gust 2004. Two hundred forty-seven pregnant adoles-
cent females (62% of eligible patients) were recruited
successfully and consented for participation in our
study. Nonparticipants could not be recruited or appro-
priately consented because their parents were not avail-
able to consent, because they had language/intellectual
barriers that prevented successful completion of the
consent form or survey, or because of research staffing
limitations. For those participants who were between
the ages of 12 and 17, inclusive parental consent was
obtained before participation in the study. One quarter
of those informed about the study declined to par-
ticipate. The racial/ethnic and age composition of the
current sample does not differ significantly from the
population of adolescents served at the Women’s Pri-
mary Care Center at Women & Infants’ Hospital.
Procedures
As part of a larger study examining pregnant adolescent
girls’ pregnancy intentions, participants were asked to
provide written answers to open-ended questions re-
garding their attitudes and motivations about being
pregnant. The larger study was initially approved by the
Women & Infants’ Hospital Institutional Review Board
in December 2001. During their first prenatal visit, a
research nurse or trained research assistant interviewed
participants by using a structured questionnaire. The
questionnaire included items measuring demographics,
pregnancy intentions, feelings/reactions about their
pregnancy, birth control use, decision-making process
regarding pregnancy, support system, living situation,
sexual experiences, school and extracurricular involve-
ment, reproductive health history, substance use behav-
iors, and abuse history. After the interview was com-
pleted, participants were asked to fill out the 1-page
open-ended questionnaire.
Measures
Demographics
Participants were asked their age, ethnicity (Hispanic or
non-Hispanic), and race.
Pregnancy Intention and Reproductive History
Participants were asked to answer the question, “Think
back to the time just before you found out you were
pregnant, and how you felt about pregnancy at that
time. When did you want to be pregnant?” Participants
who indicated “Immediately (now),” “In the next few
months,” or “In the next year” were characterized as
having “intended” the current pregnancy. Those who
indicated “More than a year from now” or “I did not
want to get pregnant” were characterized as having “un-
intended current pregnancies.” Participants were also
asked to indicate (1) if they have ever been pregnant
before and (2) how many children they have. Those
who indicated they had been pregnant previously were
also asked if they had ever had an abortion and/or ever
had a miscarriage (separate questions).
Advantages/Disadvantages of Teen Pregnancy
The qualitative aspect of the study involved open-ended
questions to which participants were asked to write
down their answers. The questions appeared in the same
order for all participants:
1. Considering everything, what do you think are the
bad things or disadvantages about having a baby now
instead of waiting until you are older?
2. What do you think are the good things or advantages
about having a baby now instead of waiting until you
are older?
Coding and Analysis
In the first round of qualitative analysis, responses
were organized15 by a research assistant, and preliminary
codes were generated on the basis of occurrence of themes
or identification of patterns in the responses. In the second
round of qualitative analyses, the study’s principal investi-
gator (M.G.P.) and coinvestigator (C.R.) reviewed all data,
generating additional codes to represent both a priori and
emergent themes. Data were entered into NVIVO 6.0 soft-
ware (QSR International Pty Ltd, Victoria, Australia) and
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coded per the resulting coding scheme. The software allows
for the organization and examination of coded responses
on the basis of different groupings of participants. The
coding group met regularly throughout the process to dis-
cuss coding, modifying the coding scheme and maintaining
fidelity to coding scheme, until consensus was reached.
Group-level differences in themes and patterns were iden-
tified and reported here.
RESULTS
Participants
Two hundred forty-seven pregnant adolescent girls (mean
age: 16.8 years; SD: 1.5; range: 12–19 years) responded to
open-ended questions regarding the advantages/disadvan-
tages of being pregnant now instead of when they are
older. Participants fell into the following age categories: 48
(19.4%) were 12 to 15 years old, 94 (38.1%) were 16 to 17
years old, and 105 (42.5%) were 18 to 19 years old. Ap-
proximately half (117 [47.3%]) indicated that they were
Hispanic. The racial background of the non-Hispanic par-
ticipants included 19.4% white, 17.8% black, 4.5% Asian,
4% American Indian/Alaskan Native, and 17.9% other.
Fifty-eight girls (23.5%) indicated that their current preg-
nancy was intended (by indicating that they wanted to be
pregnant immediately, within the next few months, or
within the next year), and 189 (76.5%) indicated that it
was unintended. Seventy-three girls (29.8%) reported at
least 1 previous pregnancy, and of those, 36 (14.7% of the
total sample and 49.3% of those with a previous preg-
nancy) indicated that they already had at least 1 child. Of
those 73 who reported a previous pregnancy, 18 (24.7%)
reported a previous abortion, and 31 (42.5%) reported a
previous miscarriage.
Teen Pregnancy Advantages
The main themes found in the responses to the question
regarding advantages include denial of any advantages;
connections; benefits and positive changes; and practical
considerations related to their being young and concerns
about the future. The upper half of Table 1 summarizes
the advantage themes, subthemes, and dimensions.
No Advantages Noted
Participants who were unable to identify advantages to
teen pregnancy/childbearing voiced some powerful mes-
sages:
“I don’t know of any good things or advantages of having
a baby this young” (17-year-old, non-Hispanic, unin-
tended pregnancy, no previous pregnancy).
“I don’t think there are any. I feel teens should wait”
(17-year-old, non-Hispanic, unintended pregnancy, pre-
vious pregnancy, 1 child).
“there is no advantages I can think about right now”
(19-year-old, Hispanic, unintended pregnancy, no pre-
vious pregnancy).
PEDIATRICS Volume 118, Number 2, August 2006 505
 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
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important aspects of their lives; and how being pregnant
as teenagers will change the way that others see them.
The lower half of Table 1 summarizes the disadvantage
themes, subthemes, and dimensions.
No Disadvantages Noted
Many pregnant teens were unable to generate disadvan-
tages to being a teen mother or felt that having a child as
a teenager was no different from waiting until they were
older. Quotations that reflect this include:
“I dont [sic] regret that about having a baby. I dont [sic]
think is nothing rong [sic] with it” (14-year-old, Hispanic,
unintended pregnancy, previous pregnancy, no children).
“I don’t really think there are any disadvantages in having
a baby now, I am completely ready for this responsibility”
(17-year-old, non-Hispanic, intended pregnancy, previous
pregnancy, no children).
“I have no bad thoughts on having a baby now instead of
waiting the only difference is I’m 17” (17-year-old, Hispanic,
intended pregnancy, previous pregnancy, no children).
Lack of Preparedness
Those adolescent girls who indicated lack of prepared-
ness as a disadvantage emphasized different areas in
which they were not ready, including being too young
and lacking stability. Excerpts that illustrate this include:
“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
older I would know of what was going to happen more”
(17-year-old, non-Hispanic, unintended pregnancy, no previ-
ous pregnancy).
“1. No job to support me and my baby[.] 2. Im [sic] not out
of school” (14-year-old, non-Hispanic, unintended pregnancy,
no previous pregnancy).
“[F]inancial problems. Not waiting until I was married be-
cause I’m not sure if the father is always gonna be there”
(17-year-old, non-Hispanic, unintended pregnancy, no previ-
ous pregnancy).
“[N]ot having more life experience or education. Not fully
having my life together before trying to raise another life”
(19-year-old, non-Hispanic, unintended pregnancy, no previ-
ous pregnancy).
“The disadvantages of having a baby now instead of until I
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
my baby. It’s going to be hard to focus on school” (18-year-old,
non-Hispanic, unintended pregnancy, no previous preg-
nancy).
“[N]ot being able to go out and do normal teenage things
and not being able to do what i want when i want to” (13-
year-old, non-Hispanic, unintended pregnancy, no previous
pregnancy).
Others’ Views
There were also teens who mentioned the negative ef-
fects of how others might view them because they had
an infant during their teen years instead of waiting until
they were older. Examples of these sentiments are:
“Sometimes I feel like I should be ashamed of myself for
having a baby at such a young age. Or I feel like if other people
say things when they see me. It sometimes puts me down
because I start to wish that I should’ve done something differ-
ent” (16-year-old, Hispanic, unintended pregnancy, previous
pregnancy, one child).
“The things are that people might look at me differently and
I have to change my whole lifestyle” (13-year-old, non-His-
panic, unintended pregnancy, no previous pregnancy).
Identification of Themes Among/Between Different
Subgroups
Age
Examining the themes that were identified by partici-
pants from different age groups (12–15, 16 –17, and
18 –19 years) demonstrates the differences in how, at
different developmental stages, pregnancy is viewed (see
Table 2). Teen pregnancy was seen as enhancing con-
nections with others more often by those in the younger
age groups (12–15 and 16 –17 years), whereas practical
considerations associated with teen motherhood were
most often identified by the oldest teens (18 –19 years).
Both of these variables seemed to have an age-graded
continuum. With respect to the disadvantages identified,
it seems as though older teens are more able to recognize
(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)

PEDIATRICS Volume 118, Number 2, August 2006 507

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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)
Changes/interference 51 (69.9) 137 (79.7)
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
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 TABLE 6 Differences in Identified Dimensions According to
Whether Participants Report Previous Children Among
247 Pregnant Adolescents
Previous Child(ren) No Previous Child
(N ⫽ 36),
n (%)
Advantages
No advantages noted 2 (5.5)
Connections 24 (66.7)
Benefits/positive changes 11 (30.6)
Practical considerations 16 (44.4)
Uncertain about advantages 1 (2.8)
Disadvantages
No disadvantages noted 6 (16.7)
Lack of preparedness 17 (47.2)
Changes/interference 31 (86.1)
Others’ perceptions 2 (5.5)
Uncertain about disadvantages 0 5 (2.4)
It is particularly noteworthy that participants were
able to generate more disadvantages than advantages.
Disadvantage themes were almost always emphasized by
larger percentages of the sample than advantage themes.
Advantage themes were often unrealistic and sounded
as though participants were striving to support their
decisions to keep the pregnancy. Alternatively, society
provides far more negative messages regarding adoles-
cent pregnancy, thus making disadvantages more salient
to these teenagers. They may not be used to thinking
about what is positive or good (ie, an advantage) about
their pregnancy.
It is clear from these data that pregnant adolescents
are not a unitary or homogeneous group with respect to
their views on teen childbearing. Differences in themes
identified by girls at different ages, from different ethnic
backgrounds, and with different ideas about the intend-
edness of their current pregnancies demonstrate the
varying potential intervention targets on the continuum
of pregnancy prevention, prenatal and postpartum care
needs, evidenced within these different groupings.
Our descriptive analyses of the larger data set re-
vealed significant demographic, health-characteristics,
and contraceptive-choice differences between pregnant
teens within the age groups of 12 to 15, 16 to 17, and 18
to 19 years (M.G.P., C.R., S.W., A.M., L.P., and Z. Bill-
inkoff, unpublished data, 2006). Not surprisingly, the
advantages/disadvantages of teen pregnancy and child-
bearing also differed among these groups, which may
guide intervention strategies appropriate for each group.
For example, perhaps assisting the youngest teenagers in
identifying other ways of enhancing their connections
with others as well as helping them to realistically assess
their preparedness for motherhood and capitalizing on
their concerns about how parenthood might require
major changes and interfere with important goals might
help in preventing pregnancy.
The recent decline in teenage childbearing has not
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been uniform across racial and ethnic lines. From 1991
to 2002, birth rates among non-Hispanic white, Ameri-
can Indian, and Asian/Pacific Islander adolescents, 15 to
19 years old, declined 33% to 36%. Among non-His-
(N ⫽ 211), panic black teenagers (15–19 years), pregnancy rates
n (%) have plummeted by more than half. In contrast, the
birth rate among Hispanic adolescents declined only
9 (4.3) 20%.16 To develop effective sexual-health and pregnan-
96 (45.9)
cy-prevention programs, we need to understand the
71 (34)
78 (37.3) possible reasons behind this differential decline. Our
14 (6.7) data suggest potential targets for intervention. For ex-
ample, including ideas for enhancing relationships with
33 (15.8) others, capitalizing on lower expectations for positive
102 (48.8)
changes and benefits, and enhancing realistic assess-
154 (73.7)
5 (2.4) ments of preparedness may enhance current strategies
used for preventing pregnancies and/or preparing for
healthy pregnancies and infants among Hispanic teens.
Perhaps the most interesting differences in the
themes identified came in comparing those teenagers
who reported that they intended the current pregnancy
compared with those who reported that the current
pregnancy was unintended. Enhancing connections,
benefits/positive changes, and practical considerations
were all more likely to have been noted by those with
intended pregnancies. Even more striking were the
number (almost one third) of those who intended their
pregnancy who indicated no disadvantages to teen
pregnancy and childbearing. Although it is difficult to
measure pregnancy intentions after an individual has
already become pregnant, the 58 participants who indi-
cated that they desired a pregnancy immediately, within
the next few months, or within a year certainly seem to
view teen pregnancy differently, particularly the ad-
vantages.
Finally, it was instructive to examine the manner
in which teen pregnancy/childbearing was viewed by
those with previous pregnancy experience and by
those who already had children. The differences identi-
fied here may help us to identify ways of reducing repeat
pregnancy and childbearing in adolescents. Again, with
both groups, it is important to discuss the perception that
teen pregnancy/childbearing enhances connections/
relationships with others and assist these teens to iden-
tify other means of connecting with others in their lives.
It is also important to capitalize on their identification
of change/interference as disadvantages of adolescent
pregnancy and childbearing in assisting them to protect
themselves from subsequent pregnancies, if that is con-
sistent with their desires.
Our study is not without limitations. Ours was a
convenience sample of pregnant adolescents who were
attending their first prenatal visit; therefore, we are not
able to generalize our findings to nonpregnant teens or
pregnant teens who decided not to continue their preg-
nancy, who did not seek prenatal care at all, or who
sought care elsewhere. However, qualitative research
PEDIATRICS Volume 118, Number 2, August 2006 509
seeks to identify the range of responses that individuals
can offer to a particular question or issue rather than
apply their findings to larger populations from which
samples are drawn, so the representativeness of the sam-
ple is less of a concern for our project. We must also
acknowledge that our requirement of written responses
may have biased our results in that participants might
have provided more information and more detailed re-
sponses if the questions had been posed face-to-face by
interviewers; however, in an effort to increase open and
honest responses, we elected to use the written format.
Future research ought to pose these same questions
to broader samples of teens, including male adolescents,
to explore potential differences in themes that might be
identified by those who are not already facing a preg-
nancy to tailor pregnancy-prevention messages to these
teens as well. Additional studies might expand on our
qualitative approach beyond brief open-ended questions
to include in-depth interviews or focus groups. Such
work might help us to understand how concepts of
advantages and disadvantages of teen pregnancy/child-
bearing are weighed by individuals and how these de-
liberations influence decisions regarding preventing
pregnancy, as well as termination of pregnancy or car-
rying a pregnancy to term.
Our project extends our understanding of adoles-
cents’ views of how pregnancy during their teen years
can provide advantages and pose disadvantages/chal-
lenges. The variety of themes identified illustrates the
range and complexity of their thinking about this topic
during the beginning of their pregnancies. Of particular
note was the strong emphasis placed on the advantages
of teen pregnancy in enhancing connections with oth-
ers. As teens are assisted in identifying other means of
connecting with the important others in their lives, rates
of teen pregnancy may decline even further. Our find-
ings challenge the notion that pregnant teens can be
thought of as a homogeneous group with whom we can
approach and intervene with the same, undifferentiated
messages. Consideration of developmental, cultural, and
experiential differences among these teenagers will assist
us to better match our intervention and prevention
strategies to their ideas and needs.
510 ROSENGARD et al
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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
Updated Information including high-resolution figures, can be found at:
& Services http://www.pediatrics.org/cgi/content/full/118/2/503
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