Adolescent girls who experience abuse or neglect are at an increased risk of teen pregnancy
- Correspondence to: Dr Judith W Herrman, School of Nursing, University of Delaware, 375 McDowell Hall, Newark, Delaware 19716, USA;
Commentary on: 
Implications for practice and research
Young women experiencing maltreatment may benefit from assessment of their risk of teen pregnancy and attitudes toward the teen parenting experience.
Research should continue to explore the impact of neglect and sexual abuse on life trajectories to inform counselling, sexual health education and life goal-focused interventions.
Reductions in the rates of teen births in the USA may be attributed to increased education and services for teens targeting sexual activity, decision-making and methods of pregnancy prevention.1 Teen birth, pregnancy and abortion rates have decreased since the 1990s due to decreased rates of sexual activity among teens and increased use of contraception among sexually active teens.2 Although a positive overall trend for society, teen pregnancies and births are characterised by significant ethnic, racial, economic, geographic and contextual disparities. Noll and Shenk examined an important contextual factor, maltreatment and its association with subsequent births. Their findings identify predictors of teen births and are valuable in developing programmes and policies designed to prevent or delay teen pregnancies and births among the most vulnerable of populations.
This prospective study questioned nulliparous females (n=435), aged 14–17 years, annually until they turned 19 about their birthing history. The sample included young women who sustained sexual abuse, physical abuse or neglect and a comparison group which was matched based on selected demographic variables. The researchers confirmed reported births with hospital records, and episodes of maltreatment with protective service reports. The sample of women experiencing maltreatment was derived from protective service agencies and the comparison group was recruited from health clinics. To control for the degree of sexual activity and use of contraception, the researchers gathered and used this data to isolate maltreatment as a predictive variable.
There were 70 total births, 54 (20.3%) were among young women in the group experiencing maltreatment and 16 (9.4%) in the comparison group. Though both groups demonstrated birth rates well above the national average, girls experiencing maltreatment were twice as likely to experience a teen birth as those who did not. Those reporting sexual abuse or neglect were significantly more likely to experience a birth than women experiencing physical abuse or no abuse. The authors assert that sexual abuse and neglect are more powerful predictors of subsequent teen births than any other demographic variables, neglect serving as the most prominent predictor.
This study demonstrates sound methods including controlling for several potentially confounding variables, verifying self-reported findings, high participant retention rate (97.5%), and sound-matching principles, therefore contributing to validity and reliability of findings.
That young women with a history of neglect and sexual abuse sustain the highest birth rates, should inform our current prevention efforts. Evidence suggests that these factors are potent predictors, wherein personal and emotional needs are unmet, and point to the potential for a birth of a child to fill such voids. As noted in a focus group study of adolescents, young women often become pregnant to ‘have something to love’.3 An important new realm of research focuses on teens’ attitudes toward the parenting experience and researchers correlated positive attitudes toward a teen birth with an increased risk for subsequent births.4 ,5 Young women suffering from sexual abuse and neglect, with lives full of stress and anguish, may see the birth of a child as a way to repair complex circumstances, exert power and change in their lives, and create a better future for themselves and their children.6 Therefore, this research provides an important link for those at risk for teen births.
Partnerships between protective services, healthcare providers and sexual health experts should be fostered to provide information, counselling and support. This will ensure the identification of young women at risk and the development of strategies to provide accurate sexual health information, communicate realistic expectations about parenting, support obtainable life goals, and create pathways to success within current circumstances. Nurses are well positioned to identify teens at risk, provide or refer them for education and counselling, and to connect them with support to ensure healing from trauma. This will help break cycles of violence and abuse and encourage planned childbearing in order to foster health and happiness.