ADOLESCENCE is generally viewed as a period of turmoil. Psychoanalytic writings tend to describe numerous psychiatric symptoms that appear, change, and disappear during adolescence as part of t.he normal growing-up process.’ The psychoanalytic vie\\ point emphasizes the channeling of sexual impulses and postponement of sexual esperimentation as a necessary step in the adolescent process and the occurrence of sesual experimentation leading to inttwourse before marriage has been generally considered sexual “ac.ting out” (especially in the female).’ From ~~~~t~~ro~)olo~ic~~l studies, WC know that there are wide variations in ho~j sexual activity is considered by dit’t’erent cultures. N’ith the present changes in attitudes and twhavior in the sexual sphere of OUI societal norms and with the advance in contraceptive methods it is becoming \‘erv difficult to define what kind of sexual expression (holding hands, kissing, all stages of’ petting or sexual intercourse) is considered
normal and healthy for a particular age. Since acceptable sexual beha\,& is so culturally bound> the use of overt sexual expression as a criterion for intrapsychic pathology is becoming increasingly questionable. Schmideberg’ defined the factors which delay heterosexual relations in adolescence in thi.sculture as (1) strong family attachments, (2) idealizations of love and marriage. (3) religious and ot.her cultural ideas, (4) adult supwvision and avoidance of’ exw&e erotic stimulation, and (5) various forms of sublimations such as physical activities and cultural intcrew. 111 the study to be reported, WC address ourselves to several of these factors. W’hen sexual intercourse starts at in early age, the chance of pregnancy in adolescence mcwases. 011 a national level. Kantner and Zelnic k“ found that among sexually active 15 to l%year-old girls, nearly three out of 10 becamp pregnant. Locallv. in the state of North Carolina, Steahr’ reported that in contrast to a general trend toward decrease, nonwh~tc birth rates for girls 1,5 through 19 years of age have* remained at the same level as previously.
Beckground, history, and geneml expbanatkm of the present study ,411 unwanted pregnaricy in early adoltwence is a wry unfortunate went in a variety of ways for the girl who experiences it, for the familv which most of the time has to take the financiat and emotionat burden ol rearing or helping to rear the child, somt~timc!s for the male involved, ad tnost of’ all f-or the unmanted child. N’e started weing patients who were rtyuesting an abortion at X.C.M.H. iI1 the latter part of. 1969. ‘l’he state of Korth C:arolina hacl passed an amendment to 459
460
Gispert
and Faik
80
80 m
70
ABORTION
60
%
60
%
50
40
30
30
20
20
IO
IO
0
0
Fig. 1. Appearance. Chi square = 17.550 with 4 degrees of freedom; significance = 0.0015. Number of missing observations = 20.
-
ABoRTION
0
TERM
m
CONTRoL
% ”
ABORTION
m
CONTROL
50
40
1;
m
70
60 50
40
30
SPECIAL EDUCATION
REPEATED GRADES
&JONE
Fig. 2. Educational problems. Chi square = 25.750 with 4 degrees of freedom; significance = 0.001. Number of missing observations = 22.
the existing abortion law in May, 1967, that permitted interruption of a bregnancy by a doctor “If he could reasonably establish, among other things, that there was substantial risk that continuance of the pregnancy would threaten the life or gravely impair the health of the said woman.” The terms “substantial risk” and “gravely impair” the health of the woman were vague and were interpreted in different ways by different doctors. Since physical health was seldom threatened, the mental health of the woman was to be considered more often. In the beginning, three physicians needed to agree and sign the recommendation for the abortion and it was generally assumed that one of the three
Fig. 3. School performance. Chi square = 25.744 with 4 degrees of freedom; significance = 0.00 1. Number of missing observations = I.
would be a psychiatrist. Being a child psychiatrist ver! interested in adolescents, Dr. Gispert was asked to see the pregnant teenagers (16 and younger) who were requesting a “therapeutic abortion.” Since the adolescent is considered a minor, one of the parents has to consent and sign the approval form, so at least one of the parents was also interviewed-separately-after the interview with the girl. In several cases, when discrepancies in their stories, disagreements about their wishes, or problems in the relationship ancl/or communication in the family appeared, and it seemed that these would interfere with the resolution of the crisis, the adolescent and the parent were seen togethel and the problems were further discussed. Since abortion was such a controversial issue and the psychiatric literature had very conflicting reports about the effects of abortion on women, we decided to do a follow-up of the first 7 1 patients seen, about 8 months after the abortion.6
Present study We are currently carrying out a longitudinal study on three groups of adolescent girls 13 to 16 years of age. There have been girls 10 and 11 years of age in the abortion group but they were unable to complete the psychological testing. In this paper, we are confining ourselves to the black teenagers, since we could not locate a large enough group of white adolescents who carried their pregnancy to term for making statisticall? meaningful comparisons. We have designated the groups as follows: in the abortion group are girls who became pregnant and chose abortion; the term group comprises girls who
Sexual
80
m
ABORTION
7n
0
TERM
5
CONTROL
experimentation
and
pregnancy
in black
adolescents
4fil
r”
60 %
50 40 30 20 IO 0
DROP
OUT
FINISH
H.S,
iWS. OR TfXH.
COLLEGE
Fig. 4. Educational goals. Chi square = 39.941 with 6 degrees of freedom: Number of missing observations = 5. chose to have their baby; the control group is composed of girls from a similar age and socioeconomic background who have not had a pregnancy. We will present some observations and comparisons obtained at the time of the initial interview with the girls and their parents.
significance = 0.001
75 70 65 -
m
ABORTION
60 -
q
TERM
55 -
fzzl
CONTROL
50 Method We gather information through semistructured interviews with the girls and simultaneous but separate interviews with one or both parents, using a multichoice questionnaire completed by the interviewer? with ample space to record verbatim both girl’s and parents’ statements. We administer a psychological test, the Rodgers Combined MMPI-CPI (Minnesota Multiphasic Personality Inventory and the California Psyc-hological Inventory). In order to obtain norms for the MMPI and CPI for this age population, we administered the test to a sample of 465 adolescent girls from eighth, ninth. tenth, and eleventh grades in the Chapel Hill and Durham city school systems. The control sample, matched by age and race, was selected from this group. The interview focuses on these general area: the subject’s functioning in the family, in school, with peers: her sexual history (dating); the impact of the pregnancy (in the two pregnant groups); plans for the future in reference to the care of the baby (in the term group); life goals such as marriage, number of children, educational plans, and occupational plans.
Resutts The following data were compiled from interviews with 2 I4 black adolescents. The mean ages of the 80 abortion candidates, the 64 pregnancy-to-term sub.jects, and the 70 control subjects were 14.6, 16.4, and 15.0 years, respectively.
45 40 35 30 25 20 I5 IO 5O-
ONLY IN MARRIAGE
ANYT%k
Fig. 5. Attitudes about when intercourse is accepabie. Chi square = 21.63 with 4 degrees of freedom: significance = 0.001. Number of missing observation+ = 16.
Appearance. The interviewer made a sub-jective evaluation of the attractiveness of the girl which included her physical appearance, her demeanor, and her reaction to us (Fig. 1). performance in Education. The girls’ academic school was categorized according to whether they had had no problems. had attended a Special Education class, or had repeated one or more grades (as judged by a discrepancy between chronological age and grade level) (Fig. 2). School performance. The grades obtained corrvlated with the above information in thai across all
462
Gispert
and
Falk
IO0 95 r
90 85 80 75 -
m
ABORTION
0
TERM
70 65 60 -
m
CONTROL
m
SEXUALLY
ACTIVE
CONTROL
55 -
NO PLANS NO Fig. 6. Conuxeptive Number of missing
plans. Chi observations
square = 13.
= 42.00
NO DATES INTERCOURSE with
PLAN
6 degrees
Tahle ;i
m
ABORTION
70
0
TERM
TO USE
of freedom;
I. Time
significance
between
first
= 0.001.
intercourse
‘~hrtion Pregnfuq
ALWAYS
SOMETIMES
38
17
38 23
41
square = 13.1946 = 0.005.
and
half
more
cent
reported
6 months.
ship
as casual, per
The
term
school
girls for
include due
the
group
control
subjects
following
and
in this
pregnant
the
Educational similar
were
girls
numerous
girls
to a pregnancy
pattern
sample
(Fig.
did then
best, the
actually
and
our
who
dropped
with
term
the
and
group.
numbers
do
out
75
not
they
Educational of educational
end-goals
follow
achievement
a
told
Dating. “take
The
group,
13 for
Relation had
mrere
allowed
at a mean
group, go “group on dates alone” group
girls
company”
with
the
term
age
group,
by of
their
14 for
and
14 for
dating” a few months in the same year. putative
a relationship
father. that
Half had
parents the
mother
the
later* of the
lasted
less
to
abortion
than
only
reasons father.
abortion
boy 6
per
and
problem.
in
told
her
lither cent
5 per
36 of
in per
the
xvas not
cent
50
cent
per
The
to fear
told
the
keep
was
with
the
about
who The
of
cent
cent. the
group.
of Thy
abortion Only
one
of the
pregnancy
group
as cotnpared
term
group.
were given for not involving Sometimes the girl had “broken preferred
as
first.
abortion of
group
in 30 per
term
Father
of the
abortion
pregnant.
first
group
cent
it
question
hoyfriend
first per
putative
with “go
told
patient
The
of being
term
and
described
relationship
suspicion
the
20
the
the
the
\vas
the
through
told
relation-
group.
of
of their
and
all in 44
control and
term
first ancl
abor,tion
4).
the
group
cases
group
(Fig.
of
of
term more
sub.jects
who
cent
the
the
abortion
Those per
is obtained
abortion
of school
the
goals.
cent
In
Sig-
lasting
described
were
girls.
perspective
boyfriend
3).
to that
per
freedom;
6 months.
who
cent
48
of
a relationship
those
included
-41
2 degrees
than
per
term
Another
in a special
Of 46
cent
“serious” levels
with
78 per
than 25
abortion
grout (75)
Within 1 yr. of’first intercourse From 1 to 2 yr. More than ? yr.
group Fig. 7. Use of conuxxptives prior to pregnancy. Chi scluare = 48.49 with 4 degrees of freedom: significance = 0.001. Number of missing observations = 3.
Turn
C%)
months,
NEVER
group
owwriq
*Chi nificance
grade
ancl
pregnancy*
him
expressecl
Different the up’.
completely that
at
putative with the out
he
might
of’ the tell
Sexual
75 70 65 60 55
experimentation
m
ABORTION
m
TERM
and
pregnancy
in black
aUolescenW
463
O/L %I 45 40 3s
30
25 20 I5 IO 5 0
WORRY
FEAR
SADNESS
HAPPINESS
EXCITEMENT
ACCEPTANCE
Fig. 8. Girl’s reaction to pregnancy. Worry: Chi qua-e 9.44; significance = 0.002. Fear: Chi square 2.5.SO:significance = 0.001. Sadness: Chi square 14.26: significance = 0.001. Happiness: Chi SC~LIW~~ 1?~.79: significance = 0.001. Excitement: Chi square I l.G2; significance = 0.001. ,Icceptancc~ Chl orherb. Sotnc of the girls \vere planning to continue m+w difference betlveen the two pregnant groups N ith regard to the age at Tvhich they started to have irt~ercottrse. About one third of each group began at 13 wars or vounger. a third at 14, and a third at 15, lvith less that1 IO per cent beginning intercourse at 16. 0f the cottwot girls. 72 per cent denied having had intercourse, mcl onlv a f’ottrth were considered sexualh aclive. Of the sexualh active controls, atmost half sLtrWd having itt~ercourse at 15 years of age. Intercourse experience. 111 the two groups which had become pregnatt~. the pregnancy occurred Ivhen the girls rvp~~rted havittg had intercourse with the putaC\e l’ather “less thart fiye times” in 39 per cent of the ah-htt group but itt onI1 18 per cent of the term group. The wrttt girls tttore frequently reported haying intercourse tnot-e than 1%5times (5 I per cent), as wmpared with the abortion group (26 per cent), with the sis to 1.7 times incidence being atmost equal for both groups (abortion , 26 per cent; term, 32 per cent). These clifferences are significant at the 0.005 level. ~1%~ periods ot’ time elapsing in the t\\‘o groups between first intercourse ancl the occurrence of pregnattc! arc presented in ‘Table I. Contraceptive plans. The control subjects were divided between the ones who denied having had intercourse and lhose who said they had (Fig. 6). We assumed the 11~0 groups to be different, in that the Ialter had been cortfronted with the need to use contraceptives 01. risk a pregnancl’.
Use of contraceptives. The gn)ttp \\ ho ‘hhxys” usecl a contraceptive ~‘as ohviottsly not 1, elf represented in the ova pregnant groups (Fig. 71. In these cases the pregrtancl. can be explained cmly by contracepCve fAitu1.e (IVD’s, “busted” cond~~~tts. etc.). ‘12te girls who ciairtted to be taking the* pill \~cre not included in the “always” categor!- txcaus~ It \\as fi)uttrl that the\ lvere takittg their pill5 irregularI! or hacl cliscotttinued their USC. This reminds us dtat the effc~tiveness of the birth corttrol pill is ~on~in~en~ art regutar ingestion and there is in this age groulb. The LISC of’ contrace@ es irt the abor&m and tetxtt groups \vas cross-tabulated wide the ~‘IxY~u~~I~~~~ of itttcrcourse, rtwaling an increased USC of. COIII raq~~i\es >IS intercourse increased from ‘%3s than five titites” (0 “mow than 15 times..’ The number 01. girls “ttw,er” using contraceptives decreased, but no1 dx& alla. with the regularitv of intercourse (from 83 to (i I per cent). Girl’s reaction to the pregnancy. Ltti’t TVt utm~ely, (I tt ww groups of pregtianl adoleswrt~s 1, ct-cs first inWrviewecl at differettt stages of their preg~~:tttc\ (Fig. 8). ‘rhe aborliott q-ottp were on the :~\cr,qe in (h&t. fourteenth week and the term girls itt their twctttyeighth week. This fact alone probabi> ittfltt~wed the responses to a significant degree. When the pregnancy appeared to [Item iis a strong possibilitk. tlvo thirds of the abortion group and one thitxl of the ~c~tns had nttrtterotts I’c~II-\. l’ht, I~IOSI frequent fears were about their parctit\. reacCorts, anCcipating anger and criticism, and i:t 5otw cases voicing fears of bodily hartn, or of beittg Thrown ottt of’ their homes, Others were af.raid of ~.Itat the shock inight do to the parents (if lhev were sic k. nervous. akwholic, etc.). Most frequetitlv. it 1, as tlot onh the pregnancy per se that they were ~OIKCIYI~Y~ aboui bttt atso the fact thal the parents w0ttM km>\\ about fheir
464
Gispert and Falk
m
IO0
IOOr
ABORTION
90
80 70 %
ii %
30 20 IO 0
!?a -
40 30-
BABY
ABORTION Fig.
9. Outcome of friends’ or relatives’ pregnancy. Chi square = 28.07 with 2 degrees of freedom: signif% cance = 0.00 1. Number of missing observations = 7.5.
m
NEVER
SPECIAL
CDNDtTlONS ONLY
ALWAYS
Fig. I I. Girl’s attitude toward abortion. (Ai square = ,X.032 with 4 degrees of freedom: significance = 0.001. Kumbex~ of missing observations = 24.
too go
0
ABORTION
too
r
80 70
6.
60
m
AB~TION
0
TERM
70
5%50
60
40
% 50 40
30
30
20
20 IO
IO 0 Fig. 10. Sisters
0
YES
NO
NEVER
S@ECiAL
~~10~ ONLY
ALWAYS
had become pregnant before = 13.60 with 2 degrees of Number of missing observa-
Fig. 12. Parents’ attitudes toward abortion. Chi square = 25.704 with 4 degrees of’ freedom; significance = 0.001. Number of missing observations = 73.
sexual activity. The majority reported that their expectations had been much worse than what actually happened when the parents were informed. (Butcome of friends’ or relatives’ pregnancies. As one would expect, term girls reported a greater number of- friends who had had babies (Fig. 9). Abortion candidates mentioned a greater proportion of friends who had had abortions. We feel that both groups would probably have under-reported abortions, however, since most people do not discuss abortions after the event. The contro1 girls mentioned that they knew of three times more cases of friends or relatives who had had bdbies than abortions. Sisters of girls who had become pregnant before 20 years of age. More abortion than term patients re-
ported that their sisters had become pregnant beforc they were 20 years old (Fig. 10). Moreover, it is interesting that the two pregnant groups’ sisters were markedly more prolific than those of the control group. Girls’ and parents’ attitudes toward abortion. WC noted that the girls’ attitudes toward abortion were slightly more liberal than their parents’. However, the same pattern was present (Figs. I I aud 12). Reasons for seekiq termination of the pregnaucy. The pregnant adolescents who seek interruption of their pregnancy report the following reasons: 86 per cent do not want a child now (a simple choice); 79 pet cent want to continue their education, and they view a child as an interruption to or impairment of this goal;
of suejects who 20 years of age. Chi square freedom: significance = 0.001. tions = 14.
Sexual experimentation
7Y per cent see themselves as emotionally immature, ttot ready to take the responsibihty and provide the care that a child requires; 67 per cent feel their body is not fully developed; 42 per cent say that their parents are unwiliing or unable to help them with the child; 28 per cent are afraid ofcommunity criticistn (scandal): 27 per cent feel that giving the child up for adoption ~ouid be unacceptable to them; i 9 per cent tnentioned that abot%on would help to avoid family strife; 17 per cent memioned that financial problems at home were an important factor; 13 per cent said that breaking up l\ith the bovfrierld (putative father) was a tnajor consid~:ratioti. 01hcr reasons very seldom mentioned were that the boyiriend refused to marry her. that they do not wish to get tnarried for this reason, and medical causes. PsychoIogical testing-MMPI. \%‘e used a comroi group of 437 girls to consWuct our own norms. Twent!-eight tests were considered invaIid and tsere exciudtd, as were profiles frotn girls \vho were known to have had a pregnancy. A brief’preiiminary scaie-byscale comparison of the M MPI data was completed for ali three go-oups. Ail resuits repot-ted are significant at better rhan the 0.05 ievel. ITor ail ages, both the term girls and the abortion group suf&reci tnore severely from feelings of despair and worthiessness rhan did the controls. They were Iess buoyant physically anti showed a decreased energy ie\~A IO addirion, the abortion group alone scored higher than the control group on a scaIe reffecting ciegwe t)f family disturbance. This is IO be expect.ed, in thar an iiie,giritnate pregrtartcy was more at variance with the. fittnily’s goats and values in this group than was true of the term group families. The term girIs felt tnore A-onicaiiy socialiv isolated than did the corm-oi subjects and the abot%on girls and this was particulari) so iu the younger age group (14 and younger). Girts having their babies were thus dislocated from peer and familv interact.ions, and had been so for some time. ‘I%c older tcrtn girts (15 and older) seemed to he fecliI3g 2 seitse of- social disgrace and were trying to make themselves look good. whereas this %$-asnot the cwt’ with control sttbjccts. Since psychoiogicai testing was administered to the experimental groups during the crisis period represemed by it pregnancy with different expected outcomes. no conclusions cm be drawn about the chroni(.ity or ac.urcness of rhese emotional reactions when comparisons are made across any groups. In other words, no COKW/ inferences can be drawn about psychotogical fztctors Fvhich tnight identify a “high-risk” poppylation. i%c had a small sampie of five control girt5 (not
and
pregnancy in black
~d~~esce~ts
465
466
Gispert and Falk
younger the girl, the more justified she and parents feel in seeking an abortion. Parents exert more pressure on the younger adolescents (10 to 14 years of age) to terminate the pregnancy unIess they themselves are l+illing and able to assume the parenting role for the offhpring. In generaI, the girls in the three groups were physically healthy, attractive, and related well to the interviewer. The nonpregnant control girls reported the fewest problems in school and, judged by their grades, performed better and had higher educational goals for the future. We can speculate that their interest and success in school contributed to their more cautious heterosexua1 experimentation. The abortion group Isas intermediate between the control and the term groups. The pregnancy-to-term girls as a group had more difficulties in school. reporting lower grades and striving for less formal education. We can assume that the pregnzmcy curtailed their educational go& but it is still apparent that they were poorer students before the pregnancy occurred. Having a baby may have been a l~echar~is~i to enhance their self-esteem, probably related to a romanticized idea of motherhood. Forcing a marriage did not seem to be the purpose of the pregnancy. It is very clifficult to ascertain the maturity and intimacy of the adolescents’ heterosexual relationships. The reported dating stages varied from case to case. It is not surprising to find a high proportion of discontin~lati~)xi of the reIati~~nship with the putative father, for in some cases no relationship had existed. Adolescence is an age for experimentation and learning. The younger the girl chronologically and emotionally, the less probable it is that she would sustain an on-going heterosexual relationship with a man who is only a few years older than she. The fact that adolescents are willing to have sexual intercourse at earIier ages, while going steady or in a close relationship, exposes them to a pregnancy when
they do n0t Cdke appropriate preventive measures. Lt.
normal and healthy for a particular age. Since acceptable sexual beha\,& is so culturally bound> the use of overt sexual expression as a criterion for intrapsychic pathology is becoming increasingly questionable. Schmideberg’ defined the factors which delay heterosexual relations in adolescence in thi.sculture as (1) strong family attachments, (2) idealizations of love and marriage. (3) religious and ot.her cultural ideas, (4) adult supwvision and avoidance of’ exw&e erotic stimulation, and (5) various forms of sublimations such as physical activities and cultural intcrew. 111 the study to be reported, WC address ourselves to several of these factors. W’hen sexual intercourse starts at in early age, the chance of pregnancy in adolescence mcwases. 011 a national level. Kantner and Zelnic k“ found that among sexually active 15 to l%year-old girls, nearly three out of 10 becamp pregnant. Locallv. in the state of North Carolina, Steahr’ reported that in contrast to a general trend toward decrease, nonwh~tc birth rates for girls 1,5 through 19 years of age have* remained at the same level as previously.
Beckground, history, and geneml expbanatkm of the present study ,411 unwanted pregnaricy in early adoltwence is a wry unfortunate went in a variety of ways for the girl who experiences it, for the familv which most of the time has to take the financiat and emotionat burden ol rearing or helping to rear the child, somt~timc!s for the male involved, ad tnost of’ all f-or the unmanted child. N’e started weing patients who were rtyuesting an abortion at X.C.M.H. iI1 the latter part of. 1969. ‘l’he state of Korth C:arolina hacl passed an amendment to 459
460
Gispert
and Faik
80
80 m
70
ABORTION
60
%
60
%
50
40
30
30
20
20
IO
IO
0
0
Fig. 1. Appearance. Chi square = 17.550 with 4 degrees of freedom; significance = 0.0015. Number of missing observations = 20.
-
ABoRTION
0
TERM
m
CONTRoL
% ”
ABORTION
m
CONTROL
50
40
1;
m
70
60 50
40
30
SPECIAL EDUCATION
REPEATED GRADES
&JONE
Fig. 2. Educational problems. Chi square = 25.750 with 4 degrees of freedom; significance = 0.001. Number of missing observations = 22.
the existing abortion law in May, 1967, that permitted interruption of a bregnancy by a doctor “If he could reasonably establish, among other things, that there was substantial risk that continuance of the pregnancy would threaten the life or gravely impair the health of the said woman.” The terms “substantial risk” and “gravely impair” the health of the woman were vague and were interpreted in different ways by different doctors. Since physical health was seldom threatened, the mental health of the woman was to be considered more often. In the beginning, three physicians needed to agree and sign the recommendation for the abortion and it was generally assumed that one of the three
Fig. 3. School performance. Chi square = 25.744 with 4 degrees of freedom; significance = 0.00 1. Number of missing observations = I.
would be a psychiatrist. Being a child psychiatrist ver! interested in adolescents, Dr. Gispert was asked to see the pregnant teenagers (16 and younger) who were requesting a “therapeutic abortion.” Since the adolescent is considered a minor, one of the parents has to consent and sign the approval form, so at least one of the parents was also interviewed-separately-after the interview with the girl. In several cases, when discrepancies in their stories, disagreements about their wishes, or problems in the relationship ancl/or communication in the family appeared, and it seemed that these would interfere with the resolution of the crisis, the adolescent and the parent were seen togethel and the problems were further discussed. Since abortion was such a controversial issue and the psychiatric literature had very conflicting reports about the effects of abortion on women, we decided to do a follow-up of the first 7 1 patients seen, about 8 months after the abortion.6
Present study We are currently carrying out a longitudinal study on three groups of adolescent girls 13 to 16 years of age. There have been girls 10 and 11 years of age in the abortion group but they were unable to complete the psychological testing. In this paper, we are confining ourselves to the black teenagers, since we could not locate a large enough group of white adolescents who carried their pregnancy to term for making statisticall? meaningful comparisons. We have designated the groups as follows: in the abortion group are girls who became pregnant and chose abortion; the term group comprises girls who
Sexual
80
m
ABORTION
7n
0
TERM
5
CONTROL
experimentation
and
pregnancy
in black
adolescents
4fil
r”
60 %
50 40 30 20 IO 0
DROP
OUT
FINISH
H.S,
iWS. OR TfXH.
COLLEGE
Fig. 4. Educational goals. Chi square = 39.941 with 6 degrees of freedom: Number of missing observations = 5. chose to have their baby; the control group is composed of girls from a similar age and socioeconomic background who have not had a pregnancy. We will present some observations and comparisons obtained at the time of the initial interview with the girls and their parents.
significance = 0.001
75 70 65 -
m
ABORTION
60 -
q
TERM
55 -
fzzl
CONTROL
50 Method We gather information through semistructured interviews with the girls and simultaneous but separate interviews with one or both parents, using a multichoice questionnaire completed by the interviewer? with ample space to record verbatim both girl’s and parents’ statements. We administer a psychological test, the Rodgers Combined MMPI-CPI (Minnesota Multiphasic Personality Inventory and the California Psyc-hological Inventory). In order to obtain norms for the MMPI and CPI for this age population, we administered the test to a sample of 465 adolescent girls from eighth, ninth. tenth, and eleventh grades in the Chapel Hill and Durham city school systems. The control sample, matched by age and race, was selected from this group. The interview focuses on these general area: the subject’s functioning in the family, in school, with peers: her sexual history (dating); the impact of the pregnancy (in the two pregnant groups); plans for the future in reference to the care of the baby (in the term group); life goals such as marriage, number of children, educational plans, and occupational plans.
Resutts The following data were compiled from interviews with 2 I4 black adolescents. The mean ages of the 80 abortion candidates, the 64 pregnancy-to-term sub.jects, and the 70 control subjects were 14.6, 16.4, and 15.0 years, respectively.
45 40 35 30 25 20 I5 IO 5O-
ONLY IN MARRIAGE
ANYT%k
Fig. 5. Attitudes about when intercourse is accepabie. Chi square = 21.63 with 4 degrees of freedom: significance = 0.001. Number of missing observation+ = 16.
Appearance. The interviewer made a sub-jective evaluation of the attractiveness of the girl which included her physical appearance, her demeanor, and her reaction to us (Fig. 1). performance in Education. The girls’ academic school was categorized according to whether they had had no problems. had attended a Special Education class, or had repeated one or more grades (as judged by a discrepancy between chronological age and grade level) (Fig. 2). School performance. The grades obtained corrvlated with the above information in thai across all
462
Gispert
and
Falk
IO0 95 r
90 85 80 75 -
m
ABORTION
0
TERM
70 65 60 -
m
CONTROL
m
SEXUALLY
ACTIVE
CONTROL
55 -
NO PLANS NO Fig. 6. Conuxeptive Number of missing
plans. Chi observations
square = 13.
= 42.00
NO DATES INTERCOURSE with
PLAN
6 degrees
Tahle ;i
m
ABORTION
70
0
TERM
TO USE
of freedom;
I. Time
significance
between
first
= 0.001.
intercourse
‘~hrtion Pregnfuq
ALWAYS
SOMETIMES
38
17
38 23
41
square = 13.1946 = 0.005.
and
half
more
cent
reported
6 months.
ship
as casual, per
The
term
school
girls for
include due
the
group
control
subjects
following
and
in this
pregnant
the
Educational similar
were
girls
numerous
girls
to a pregnancy
pattern
sample
(Fig.
did then
best, the
actually
and
our
who
dropped
with
term
the
and
group.
numbers
do
out
75
not
they
Educational of educational
end-goals
follow
achievement
a
told
Dating. “take
The
group,
13 for
Relation had
mrere
allowed
at a mean
group, go “group on dates alone” group
girls
company”
with
the
term
age
group,
by of
their
14 for
and
14 for
dating” a few months in the same year. putative
a relationship
father. that
Half had
parents the
mother
the
later* of the
lasted
less
to
abortion
than
only
reasons father.
abortion
boy 6
per
and
problem.
in
told
her
lither cent
5 per
36 of
in per
the
xvas not
cent
50
cent
per
The
to fear
told
the
keep
was
with
the
about
who The
of
cent
cent. the
group.
of Thy
abortion Only
one
of the
pregnancy
group
as cotnpared
term
group.
were given for not involving Sometimes the girl had “broken preferred
as
first.
abortion of
group
in 30 per
term
Father
of the
abortion
pregnant.
first
group
cent
it
question
hoyfriend
first per
putative
with “go
told
patient
The
of being
term
and
described
relationship
suspicion
the
20
the
the
the
\vas
the
through
told
relation-
group.
of
of their
and
all in 44
control and
term
first ancl
abor,tion
4).
the
group
cases
group
(Fig.
of
of
term more
sub.jects
who
cent
the
the
abortion
Those per
is obtained
abortion
of school
the
goals.
cent
In
Sig-
lasting
described
were
girls.
perspective
boyfriend
3).
to that
per
freedom;
6 months.
who
cent
48
of
a relationship
those
included
-41
2 degrees
than
per
term
Another
in a special
Of 46
cent
“serious” levels
with
78 per
than 25
abortion
grout (75)
Within 1 yr. of’first intercourse From 1 to 2 yr. More than ? yr.
group Fig. 7. Use of conuxxptives prior to pregnancy. Chi scluare = 48.49 with 4 degrees of freedom: significance = 0.001. Number of missing observations = 3.
Turn
C%)
months,
NEVER
group
owwriq
*Chi nificance
grade
ancl
pregnancy*
him
expressecl
Different the up’.
completely that
at
putative with the out
he
might
of’ the tell
Sexual
75 70 65 60 55
experimentation
m
ABORTION
m
TERM
and
pregnancy
in black
aUolescenW
463
O/L %I 45 40 3s
30
25 20 I5 IO 5 0
WORRY
FEAR
SADNESS
HAPPINESS
EXCITEMENT
ACCEPTANCE
Fig. 8. Girl’s reaction to pregnancy. Worry: Chi qua-e 9.44; significance = 0.002. Fear: Chi square 2.5.SO:significance = 0.001. Sadness: Chi square 14.26: significance = 0.001. Happiness: Chi SC~LIW~~ 1?~.79: significance = 0.001. Excitement: Chi square I l.G2; significance = 0.001. ,Icceptancc~ Chl orherb. Sotnc of the girls \vere planning to continue m+w difference betlveen the two pregnant groups N ith regard to the age at Tvhich they started to have irt~ercottrse. About one third of each group began at 13 wars or vounger. a third at 14, and a third at 15, lvith less that1 IO per cent beginning intercourse at 16. 0f the cottwot girls. 72 per cent denied having had intercourse, mcl onlv a f’ottrth were considered sexualh aclive. Of the sexualh active controls, atmost half sLtrWd having itt~ercourse at 15 years of age. Intercourse experience. 111 the two groups which had become pregnatt~. the pregnancy occurred Ivhen the girls rvp~~rted havittg had intercourse with the putaC\e l’ather “less thart fiye times” in 39 per cent of the ah-htt group but itt onI1 18 per cent of the term group. The wrttt girls tttore frequently reported haying intercourse tnot-e than 1%5times (5 I per cent), as wmpared with the abortion group (26 per cent), with the sis to 1.7 times incidence being atmost equal for both groups (abortion , 26 per cent; term, 32 per cent). These clifferences are significant at the 0.005 level. ~1%~ periods ot’ time elapsing in the t\\‘o groups between first intercourse ancl the occurrence of pregnattc! arc presented in ‘Table I. Contraceptive plans. The control subjects were divided between the ones who denied having had intercourse and lhose who said they had (Fig. 6). We assumed the 11~0 groups to be different, in that the Ialter had been cortfronted with the need to use contraceptives 01. risk a pregnancl’.
Use of contraceptives. The gn)ttp \\ ho ‘hhxys” usecl a contraceptive ~‘as ohviottsly not 1, elf represented in the ova pregnant groups (Fig. 71. In these cases the pregrtancl. can be explained cmly by contracepCve fAitu1.e (IVD’s, “busted” cond~~~tts. etc.). ‘12te girls who ciairtted to be taking the* pill \~cre not included in the “always” categor!- txcaus~ It \\as fi)uttrl that the\ lvere takittg their pill5 irregularI! or hacl cliscotttinued their USC. This reminds us dtat the effc~tiveness of the birth corttrol pill is ~on~in~en~ art regutar ingestion and there is in this age groulb. The LISC of’ contrace@ es irt the abor&m and tetxtt groups \vas cross-tabulated wide the ~‘IxY~u~~I~~~~ of itttcrcourse, rtwaling an increased USC of. COIII raq~~i\es >IS intercourse increased from ‘%3s than five titites” (0 “mow than 15 times..’ The number 01. girls “ttw,er” using contraceptives decreased, but no1 dx& alla. with the regularitv of intercourse (from 83 to (i I per cent). Girl’s reaction to the pregnancy. Ltti’t TVt utm~ely, (I tt ww groups of pregtianl adoleswrt~s 1, ct-cs first inWrviewecl at differettt stages of their preg~~:tttc\ (Fig. 8). ‘rhe aborliott q-ottp were on the :~\cr,qe in (h&t. fourteenth week and the term girls itt their twctttyeighth week. This fact alone probabi> ittfltt~wed the responses to a significant degree. When the pregnancy appeared to [Item iis a strong possibilitk. tlvo thirds of the abortion group and one thitxl of the ~c~tns had nttrtterotts I’c~II-\. l’ht, I~IOSI frequent fears were about their parctit\. reacCorts, anCcipating anger and criticism, and i:t 5otw cases voicing fears of bodily hartn, or of beittg Thrown ottt of’ their homes, Others were af.raid of ~.Itat the shock inight do to the parents (if lhev were sic k. nervous. akwholic, etc.). Most frequetitlv. it 1, as tlot onh the pregnancy per se that they were ~OIKCIYI~Y~ aboui bttt atso the fact thal the parents w0ttM km>\\ about fheir
464
Gispert and Falk
m
IO0
IOOr
ABORTION
90
80 70 %
ii %
30 20 IO 0
!?a -
40 30-
BABY
ABORTION Fig.
9. Outcome of friends’ or relatives’ pregnancy. Chi square = 28.07 with 2 degrees of freedom: signif% cance = 0.00 1. Number of missing observations = 7.5.
m
NEVER
SPECIAL
CDNDtTlONS ONLY
ALWAYS
Fig. I I. Girl’s attitude toward abortion. (Ai square = ,X.032 with 4 degrees of freedom: significance = 0.001. Kumbex~ of missing observations = 24.
too go
0
ABORTION
too
r
80 70
6.
60
m
AB~TION
0
TERM
70
5%50
60
40
% 50 40
30
30
20
20 IO
IO 0 Fig. 10. Sisters
0
YES
NO
NEVER
S@ECiAL
~~10~ ONLY
ALWAYS
had become pregnant before = 13.60 with 2 degrees of Number of missing observa-
Fig. 12. Parents’ attitudes toward abortion. Chi square = 25.704 with 4 degrees of’ freedom; significance = 0.001. Number of missing observations = 73.
sexual activity. The majority reported that their expectations had been much worse than what actually happened when the parents were informed. (Butcome of friends’ or relatives’ pregnancies. As one would expect, term girls reported a greater number of- friends who had had babies (Fig. 9). Abortion candidates mentioned a greater proportion of friends who had had abortions. We feel that both groups would probably have under-reported abortions, however, since most people do not discuss abortions after the event. The contro1 girls mentioned that they knew of three times more cases of friends or relatives who had had bdbies than abortions. Sisters of girls who had become pregnant before 20 years of age. More abortion than term patients re-
ported that their sisters had become pregnant beforc they were 20 years old (Fig. 10). Moreover, it is interesting that the two pregnant groups’ sisters were markedly more prolific than those of the control group. Girls’ and parents’ attitudes toward abortion. WC noted that the girls’ attitudes toward abortion were slightly more liberal than their parents’. However, the same pattern was present (Figs. I I aud 12). Reasons for seekiq termination of the pregnaucy. The pregnant adolescents who seek interruption of their pregnancy report the following reasons: 86 per cent do not want a child now (a simple choice); 79 pet cent want to continue their education, and they view a child as an interruption to or impairment of this goal;
of suejects who 20 years of age. Chi square freedom: significance = 0.001. tions = 14.
Sexual experimentation
7Y per cent see themselves as emotionally immature, ttot ready to take the responsibihty and provide the care that a child requires; 67 per cent feel their body is not fully developed; 42 per cent say that their parents are unwiliing or unable to help them with the child; 28 per cent are afraid ofcommunity criticistn (scandal): 27 per cent feel that giving the child up for adoption ~ouid be unacceptable to them; i 9 per cent tnentioned that abot%on would help to avoid family strife; 17 per cent memioned that financial problems at home were an important factor; 13 per cent said that breaking up l\ith the bovfrierld (putative father) was a tnajor consid~:ratioti. 01hcr reasons very seldom mentioned were that the boyiriend refused to marry her. that they do not wish to get tnarried for this reason, and medical causes. PsychoIogical testing-MMPI. \%‘e used a comroi group of 437 girls to consWuct our own norms. Twent!-eight tests were considered invaIid and tsere exciudtd, as were profiles frotn girls \vho were known to have had a pregnancy. A brief’preiiminary scaie-byscale comparison of the M MPI data was completed for ali three go-oups. Ail resuits repot-ted are significant at better rhan the 0.05 ievel. ITor ail ages, both the term girls and the abortion group suf&reci tnore severely from feelings of despair and worthiessness rhan did the controls. They were Iess buoyant physically anti showed a decreased energy ie\~A IO addirion, the abortion group alone scored higher than the control group on a scaIe reffecting ciegwe t)f family disturbance. This is IO be expect.ed, in thar an iiie,giritnate pregrtartcy was more at variance with the. fittnily’s goats and values in this group than was true of the term group families. The term girIs felt tnore A-onicaiiy socialiv isolated than did the corm-oi subjects and the abot%on girls and this was particulari) so iu the younger age group (14 and younger). Girts having their babies were thus dislocated from peer and familv interact.ions, and had been so for some time. ‘I%c older tcrtn girts (15 and older) seemed to he fecliI3g 2 seitse of- social disgrace and were trying to make themselves look good. whereas this %$-asnot the cwt’ with control sttbjccts. Since psychoiogicai testing was administered to the experimental groups during the crisis period represemed by it pregnancy with different expected outcomes. no conclusions cm be drawn about the chroni(.ity or ac.urcness of rhese emotional reactions when comparisons are made across any groups. In other words, no COKW/ inferences can be drawn about psychotogical fztctors Fvhich tnight identify a “high-risk” poppylation. i%c had a small sampie of five control girt5 (not
and
pregnancy in black
~d~~esce~ts
465
466
Gispert and Falk
younger the girl, the more justified she and parents feel in seeking an abortion. Parents exert more pressure on the younger adolescents (10 to 14 years of age) to terminate the pregnancy unIess they themselves are l+illing and able to assume the parenting role for the offhpring. In generaI, the girls in the three groups were physically healthy, attractive, and related well to the interviewer. The nonpregnant control girls reported the fewest problems in school and, judged by their grades, performed better and had higher educational goals for the future. We can speculate that their interest and success in school contributed to their more cautious heterosexua1 experimentation. The abortion group Isas intermediate between the control and the term groups. The pregnancy-to-term girls as a group had more difficulties in school. reporting lower grades and striving for less formal education. We can assume that the pregnzmcy curtailed their educational go& but it is still apparent that they were poorer students before the pregnancy occurred. Having a baby may have been a l~echar~is~i to enhance their self-esteem, probably related to a romanticized idea of motherhood. Forcing a marriage did not seem to be the purpose of the pregnancy. It is very clifficult to ascertain the maturity and intimacy of the adolescents’ heterosexual relationships. The reported dating stages varied from case to case. It is not surprising to find a high proportion of discontin~lati~)xi of the reIati~~nship with the putative father, for in some cases no relationship had existed. Adolescence is an age for experimentation and learning. The younger the girl chronologically and emotionally, the less probable it is that she would sustain an on-going heterosexual relationship with a man who is only a few years older than she. The fact that adolescents are willing to have sexual intercourse at earIier ages, while going steady or in a close relationship, exposes them to a pregnancy when
they do n0t Cdke appropriate preventive measures. Lt.
