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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~ers£gr 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 o£Ppychology, 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
