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VOLUME I - ~.UI - ^ Ace FUTURE Adolescent Sex~ali~, Pregnant, and Childbearing Cheryl D. Hayes, Editor Pane] on Adolescent Pregnancy and Childbeanng Committee on Child Development Research and Public Poligy Commission on Behaviors and Social Sciences and Education National Research Council NA;I1OKAL ACADEMY PRESS Washington, D.C 1987

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineenug, and the Institute of Medicine. The members of He committee responsible for the report were chosen for their special competences and win regard for appropriate balance. Plus report has been reviewed by a group other than the authors according to procedures approved by a report review committee consisting of members of Be National Academy of Sciences, Be National Academy of Engineenng, and Be Institute of Medicine. Me National R~rch Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology win the Academy's purposes of furahenng knowledge and of advising the federal government. The Council operates in accordance with general policies determined by the Academy under the au~onty of its congressional chaner of 1863, which established the Academy as a private, nonprofit, self-goveming membership corporation. Ike Council has become Be principal operating agency of both the National Academy of Sciences and the National Academy of Engineenng in the conduct of their services to the government, the public, and the scientific and en~eenug communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineenog and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. Ibis project was sponsored by He Ford Foundation, the Rockefeller Foundation, He William and Flora Hewlett Foundation, He Robert Wood Johnson Foundation, and the Charles Stewart Mott Foundation. Me interpretaiions and conclusions contained in this publication represent the views of the panel and not necessarily Hose of the sponsonug foundlaiions, their trustees, or officers. Library of Congress Cataloging-~n-Publicat~ion Data National Research Council (IJ.S.~. Panel on Adolescent Pregnancy in Childbearing. Risking He future. Includes bibliographies and index. 1. Adolescent mowers-United States. ~ Pregnancy, Adolescent-United States. 3. Pregnancy, Adolescent- United States-Prevention. 4. Youth-United States- Sexual behavior. I. Hayes, Cheryl D. II. Title. HQ759.4.~38 1986 306.7'088055 8~31181 ISB~ ~309~36984 (`r. 1) Copyright @) 1987 by the National Academy of Science No part of this book may be reproduced by any mechaIiical, photographic, or electronic pass, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted or otherwise copied for public or private use, without written pe~l~ission Tom the publisher. Printed in the United States of America First Pruning, December 1986 Second Pnn~g, March 1987 Third Printing, June l9g7 Founh Pnnung, Mary 1988 Fifth ruing, Se~xanber 1989 Such Peg, S'ptemb~ 1990 Seventh Printing, July 1992 Fithth Pnnung, May 1993

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Panel on Adolescent Pregnarlc y and Childbearing DANIEL D. t=ERMAN (Claire, Handy Medical School WENDY H. BALDWIN, C=ter for Popoianon Beseech, Canon flute of Cam Hemp =d Human Development EZRA C. DAVIDSON, JR., Department of Obstetrics and Gynecology, C}=ries R. Drew Postgraduate Medicd School lOY G. DRYFOOS, Hasdugs~-Hu~on, New York JACQUELINE D. T:ORRESr, Alan Gur~cher Institute, New York FRANK E. F(~SI~NBERG,JR., Dependent of Sociology, Un~rers~y of Ply BED A. HAMBURG, bit. Sew Spool of Medicine, City Univem~r of New York RICHARD p~;OR, Amuse of Behavioral Science, Unnrem~y of Colorado JUDITH E. JONES, to for Population add Family Heals, Columbia Unity FRANK I.EV~ Spool of Public A~irs, U~em~y of Mallard ROBERT H. MNOOKIN, Stanford Law School KR~N A. MOOD, Cod ~ends, ~c., W~on, D.C. RON D. PARKE, Department of Ppy~ology, U~ersgr of Bows HAROLD A. RICHMAN, Chapin Hap Mate! for Cohen, National Opinion Resown C=t=, Umvers~q of Chicago hIARIS ~OVSKIS, Deparunent of ~story, Umversi~y of Michigan CHERYL D. HAYES, Study Director SANDRA Is. HOFFERTH, Advise MARGARET :E ENSMINGER, Consultant DE: ANN L. WENK, Sta~cd Consultant ~ ~ SILO, S~t~t ... IS: 1 l

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Committee on Child Development Research arid Public Poligy 1 WILLIAM A. MO9RIIL (Chair)? Mathte~' Iliac., Princeton WILLIAM KESSEN (bare Chair) Dep==ent oPpychology, Yale University EUGENE S. BA~DACH, School of Public Policy, U~ers~ty of California, Berkeley DONALD T. CAMpB~T T. D~=t of Sow R~nom, High Umv= DAvID L. COWERS, School of Low, Uni~r~gr of Mic}ligas1 FELTON EARLS, School of Mediane, Washington University, St. IJOUiS DOW ~ ENTW~LE, Depa:~eDt of Social Relations, Johns Hopkins Users FELINE T. FURSIEN3ERG, 3R., Department of Sociology, University of Pe~rl~a HERBERT GINSBURG, Department of Home Development, Columbia Unwersi~y SHEILA B. KAbIER~N, Spool of Social Work, Columbia U~ernty LUIS M. LAC)SA, Edu=nonal Tesimg Service, Princeton, N.J. SAMUELJ. MESSICK, Educational Testing Service, Princeton, N.J. JOHN MODELL, Department of History adds Philosophy, Urn-+Mdlon University T.M. 1IM PARHAM, Spool of Social Work, Univerny of Georgia MICHAEL ~ . R~R, Instimte of P~rchiany, U~2nress~ty of London EUGENE SMOLENSEY, Depa~ent of Economics, Umvess~y of Wiscormn 13ARBAR~ SIARFELD, S6hool of Medicine, Johns Hopkins Curers CAROL K. WHALEN, Spool of Social Colon, Univeni~y of ~lifon~ia Irvine DANIEL D. OVERMAN (ex oEimo), Chair, Pand on Adolescent Pregnanq and Cb~d~ing 2V

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Contents Foreword Preface .......... Sllmma~r . . . Introcluci~on .. 1X 2 Trends In Adolescent Sexuality and Fertility 3 The Sometal Context 4 Determinants of Adolescent Sexual Behavior and Decision Making . ~ . e Consequences of Adolescent Childbearing 6 Preventive Interventions ............ 7 ~nterven~aons for Pregnant and Parenting Adolescents 8 Prion~aes for Data Collection and Research 1 .. 15 . . 33 75 ..... 95 ,,123 141 .. .. 189 ,..,..,..231 9 Prionnes for Policies and Programs . ... .... ....... 261 References ..... ~= ..... v 325

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Volnune II, Working Papers Contents Adolescent Pregnancy and Childbe~g: An Emerging Research Focus, Cheryl D. Hayes i Influences on Early Sexual Ed Fertility Behavior Initiation of Set Intercourse, Sandra L. Hofferth Sew Behavior and Other Transition Behaviors, Margaret Ensminger Contraceptive Decision Making, Sandra L. Hoffenh Teenage Pregnancy and Its Resolution, Sandra L. [lofferth Consequences of Early Sexual ~d I:ertility Behavior Health and Medical Consequences, Donna M. Strobino Social and Economic Consequences of Teenage Parenthood, Sandra L. Hofferth Teenage Fatherhood, Ross D. Parke and Brian NeuiFe Chidden of Teenage Parents, Sandra L. Hofferth Programs ~d Policies Ejects of Programs and Policies, Sandra L. Hofferth Measunng Program Costs, Martha R. Burt with Frank Levy References Staiisucal Append&: Trends ~ Adolescent Sexual and Ferocity Behavior, Kristin: A. Moore, Dee Ann L. Wenk, Sandra L. Hofferth, and Cheryl D. Hayes Volume II is available for sale through the Publicanon-on-DemaDd Program of He Nanonal Academy Press. vii

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Foreword Adolescent pregnancy and childbearing are matters of substantial na- nonal concern. Even the analysis and descnption of these phenomena, much less prescnptions for altering present trends, are highly controver- sial. And it is all too easy to avoid or to deal only obliquely with issues that arouse so many deep-seated emotions and convictions. There is, nonethe- less, broad agreement that the personal and public costs resulting from unintended pregIlanaes and untimely birth are far coo high to counte- nance an indifferent response. Discontinued educations, reduced employ- ment opportunities, unstable marriages (if they occur at all), low incomes, and heightened health and developmental risks to the chidden of adoles- cent mothers are a few of the most obvious and immediate personal COStS. Sustained poverty, frustration, and hopelessness are Al too often the long- terni outcomes. Funhe~ore, the welfare, Meted, and Food Stop program COStS HI 1985 for famiLes begs by a birth to a teenager reached $16.65 billion. Programs and services to prevent pregnancy and improve the life chances of teenage parents and their children have appeared in increasing number since the mid-1970s, frequently storing up powerful or vocal advocates and opponents. An ever more ~rnpassioned debate has drawn public, private, voluntary, and philanthropic organza ions into a COOt=U- ing pursuit for "solutions" to the perceived problems. Yet, after more than a decade of experience, there seemed to many observers an imbalance in emphasis between what people believed and what polity makers, professionals, and sooety in general knew about the impacts and COSt- effeci~`reness of alternative prevention and amelioration strategies in light Lo

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x FOREWORD of better scientific knowledge about early sexual and fertility behavior. There seemed to be distressingly little discussion about how venous interventions worI;, for whom, under what circumstances, and with what intended and unintended eEects. And what were the most promas- mg directions for fixture policy and program development? Tm 1983, at the urging of several of its members, the Committee on Child Development Research and Public Policy within the National Research Council proposed the establishment of a study panel to conduct a broad and dispassionate review of relevant research and program expen- ence and to recommend approaches for policy formulation, program design, research, and evaduai:on. In 1984, with generous support from five foundanons the Rockefeller Foundation, the Ford Foundation, the William and Flora Hewlett Foundation, the Robert Wood Johnson Foundation and the Charles Stewart Mott Foundation-the P=e! on Adolescent Begs y and Childbearing began its study. Over a two-year period, this broadly mterdisc~plina~y 15-person panel and its staff and consultants undertook three major tasks: (~) to assemble, integrate, and assess data on trends ~ teenage sexual and fertility behavior; (2) to renew and synthesize research on the antecedents and consequences of early pregnancy and childbearing; and (3) to review alternative preventive and ameliorative policies and programs. In meeting its charge, the pane] developed two volumes. Volume ~ presents the panel's findings, conchs, and reco~nmendaiions. Dee tailed backgro~r~3 renews of emsimg research on factors anteing ache Donation o: sexua . intercourse, contraceptive use, pregl}a=;y and preg- nancy resolution, and the consequences of teenage pregnancy, childbear- ing, and parenting for young mothers, fathers, and their children, as well as the costs and effects of policies and programs, constitute Volume Il. Also included in Volume I} is a comprehensive stansuc~ appendix present- mg data Tom a vanety of sources on trends in teenage sexual and ferocity behavior. Throughout Volume ~ the panel refers to the papers and the stat~siic~d appendix in Volume I] to support its deliberanons. The pane] based its study on both existing information and new analyses of existing data. These sources were supplemented by workshops and individual discussions with many federal, state, and local policy makers, program designers, service providers, and evaluators, as well as site nsits to a variety of programs across the nation. In accordance with institutional pond, teds report has bun extensively and thorny renews by m&- viduals other than members of the study panel.

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FOREWORD xi In recent years, many other individuals arid groups representing an array of moral, philosophical, and political perspectives have addressed the complex and controversial issues surrounding adolescent pregnancy. Many have developed recommendations and guidelines for policy makers, service providers, parents, and adolescents themselves. This report is one step ~ a continuing process of inquiry, review, and synthesis. As a scenic body, the Pane] on Adolescent Pregnancy and Childbearing sought lo cianEy the issues, sharpen awareness of crucial decision points, and define the limits of existing knowledge. Although science cannot resolve issues that are inextricably bound to differences In human values, it can illuminate the trade-offs among different political and ideological positions, and we believe this report will inform the continuing public debate. On behalf of the members of the parent Committee on Child De~relop- ment Research and Public Policy, ~ would like to acknowledge the special co3~tnbution of Damel D. Federman, who served as panel chair. His commitment of time, energy, and intellectual resources over the past two years has been extraordinary. In large part, the success of this study is due to IS exquisite leadership. Acknowledgment is also due to the other members of the Panel on Adolescent Pregnancy and Childbeanng. AD gave generously of their rune and knowledge throughout the study. As a diverse group of individuals, they are to be commended for producing a unarumous report on a topic that mev~tably raises public controversy and . . surs personal con~ctlons. The members of the panel join the committee In extending our great appreciation to the staff of the study. Cheryl D. Hayes, the study director for the panel as well as the parent committee, once again demonstrated the enormous energy, outstanding thoroughness, and great skill for which she is wed known to many of us. Special thanks go also to Celia Shapiro' staff assistant to the committee and the panel, for her tireless attention to ad~x~in~strative detail throughout the study and for her patience and persis- tence ~ assembling the references for the two volumes. We gratefully acknowledge the significant contribution of Sandra L. Hoffenh of the National Institute of Child Health and Human Development, who au- thored many of the research rewews that informed the panel's delibera- tions and coedited Volume IT of the report. The efforts of Dee Ann Wenk of the University of Kentucky, who sensed as statisticd consultant and worked with members of the pane! and the staffim compiling the data and preparing the numerous tables and figures that appear In the report and the

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xii FOREWORD statistical appendix, are also gratefully acknowledged. Margaret A. Ens- minger and Donna M. Strobino, both of Johns Hopkins University, serve as consultants an] authored thoughtful background papers that are included ~ Volume Il. FmaDy, Chnst3ne L. McShane, editor for the Commission on Behavioral and Social Sciences and Educator, edited the report with a critical eye and managed the final production of the volumes. The pane] has also benefited Tom the contnbutions of several 3~&v~- uals who prepared special tabulations of egg data to help it address a number of ~i~icu~t issues that remam unresolved In the available research. Special thanks are due Frank Mott of the Center for Neiman Resource Research at Ohio State University, William Pratt, Mad one Hom, Chris- tme Bachrach, and Stephanie Ventura of the National Center for Health Statistics, and Stanley Henshaw of the Alan Gut~macher Institute. Many other individuals played an important role In the panel's deliberations by providing information, cnticai analysis, advice, an] reviews of the draft report and the draft background papers. Their thoughts comments and insights are reamed in the final manuscnpts. Foamy, teds Sway WOU]6 not have been possible flout the generous support of our foundation sponsors. On behalf of the Committee on Child Development Research and Public Policy, ~ would lilce tO extend spend thanks to Mary Kritz of the Rockefeller Foundation, Prudence Brown of the Ford Fo~,n&non, Anne F~reh Murray of the William and Flora Hewlett Foundation, Paul TeDinek of the Robert Wood Johnson Foundation, and Marilyn Steele of the Charles Stewart Mott Foundation. Their encouragement and advice greatly enhanced the study at every stage. WILLIAM A. MORAL, Chair Committee on Child Development Research and Public Polisher

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Preface No human experience is at once so transiently private and lastingly public as an unintended pregnant. When the mother herself is a young adolescent, only partially educated and almost wholly economically d~ pendent, the pregnancy is inevitably enmeshed in a ragged tapestry of personal, interpersonal, social, religious, ethical, and economic dimen- sions. The peculiarly human gap between reproductive maturation and social self-su~iaen~y sets the stage for the problem. Many factors beyond the control even the ken of the young people involved complicate the scene. At every port, external expectations batter on newly emerging Wives, challenging young adolescents to balance unmediate sausfaci~on and Tong-range consequences radically disproportionate from anything they have previously had to deal with. It is little wonder that ~ this very complicated arena research has been difficult and social consensus elusive. Our pane! was convened to collect, review, and evaluate the data on trends ~ adolescent pregnancy and childbearing and on the antecedents and consequences of this phenomenon and to ~ ate proposAs for the evolution of potentially helpful programs. We had the generous support of five fo~danons: the Ford Foundation, the Rockefeller Foundation, the William and Flora Hewlett Foundation, the Robert Wood Johnson Foundation, and the Charles Stewart Mott Foundation, ad of which have demonstrated a long-standing Interest ~ issues associated witch adolescent pregnant and Beaning. Many have made substantial Investments in a growing body of relevant research and a lengthening list of targeted programs. Their interest In this study-an] indeed, as a pane! of scholars and experts, our interest ~ undertaking it iS a concern about the prob ... XS2:

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xsv PREFACE lems of early unintended pregnancy and parenting in our society and what is know about how to effectively address them. Our sponsors were models of what scholars hope for generous, supportive, an] never intn}- sive. The project officers were consistently helpful, but at no time was any of OUI work constrained by the foundations nor beholden to them. The staE of the National Research Council was consistently supportive, and our study director, Cheryl Hayes, who also serves as executive officer of the parent Committee on Child Development Research and Public Policy, was at once a colleague, a paragon, and the pnucipal drafter of the report. Few people can approach the problem of teenage pregnancy dispassion- ately. Becoming; sexually active, using contraception, considering abor- tion or adoption every step is invested with a panoply of moral and religious questions, add these decisions are often undertaken alone by a Lightened and immature young woman who would be considered a child in nearly any other context. A consciousness of this poignance pervades our report, and deliberately so. The pane] believes that at each step- however much one may wish for a different outcome of a prior decision- the potentially or actually pregnant teenager should be treated kindly and warmly and should have a complete set of options available without the nterposinon of moral hounding or econorn~c bamers. In general, we believe preventive strategies should be given more public an] pnlrate support than is now available. An ~nternanonal comparison study by the Alan Gutunacher institute, of which the panel was benefi- cia~y, pronded valuable in sighs into the role of preventive services cou~tnes of comparable levels of teenage sexual activity. Many sonal circumstances are closely related to the problem of teenage pregnancy and childbearing. Youth unemployment, poverty, poor educa- lion, single-parent families, television content-all these and more are accompaniments and very likely determinants of the high rates of adoles- cent pregnancy in the United States. The hope for a solution to the problem of teenage pregnancy is illusory without simultaneous ameliora- non of some of these contnbunng factors. Pending such comprehensive change, the pane} urges prevention rather than denial, kindness rather than exhortation, and research rather than doctrine. DANEL D. FEDERMAN, Chair Panel on Adolescent Pregnancy and Childbearing