Teenage Pregnancy

BACKGROUND AND STATEMENT OF THE PROBLEM
Teenage pregnancy is a common social problem in both Western and Eastern cultures. In United States, the statistics show that more than 3,000 teens get pregnant every day and the half them give births (McCoullough & Scherman(1991), cited in Yucel, 2003). Although teenage pregnancy may be considered as a positive experience, studies show that teenage pregnancy is associated with psychological, social and physical problems. The pregnancy rates reveal that the number of unintended pregnancy is very high. Some of the complications are that teenage mothers are more likely to expose postnatal depression, poor quality of life such as economic difficulties, unfinished education and poor housing (Mayson, 2011). The babies from the teen mothers are at high risk of mortality and low birth rate (Mayson, 2011).
There are lots of researches about the pregnancy issue. At the end of the results of the studies, educators try to find a solution about the unintended pregnancy. Education programs that aim at informing teens about contraception, safety sexual behaviors and sexually transmitted diseases are designed in most countries. However, Turkey is in a disadvantaged position because of the fact that there are very few studies that accepts the teen pregnancy as a growing problem.
We also , as school counselors, mostly work with teenagers. School counselors should be educated about teenagers’ problems. Since teenage pregnancy is one of the problems teenagers face in adolescence, school counselors needs to give attention to this problem. When addressing the issue of teenage pregnancy, it is mandatory that we also talk about youth culture. Teenagers have a different kind of culture. This culture affects the way teenagers become pregnant. When considering the topic teenage pregnancy, educational and health policies should be made in order to prevent the adverse effects of teenage pregnancy.
LITERATURE REVIEW In one of the research about the adolescent pregnancy investigates the risk factors which cause males to be involved in adolescent pregnancy. It is an important study since there are a few studies which examine male factors in teen pregnancy. The aim of the study was explore the relationship between adverse childhood experiences of males and their involvement in teen pregnancy. The sample of this research was comprised of 45,000 adult members who annually undergo standardized examinations at Kaiser Permanente’s Health Appraisal Clinic in San Diego, California. They completed an Adverse Childhood Experience Study questionnaire. Childhood experience, in the study, includes verbal, physical, and sexual abuse, battered mother, household substance abuse, mental illness in household, parental separation and divorce and criminal household members. The results of the research revealed that there is an important relationship between male involvement in teen pregnancy and their adverse childhood experiences. In this respect, it can be concluded that the rate of teenage pregnancy can be mediated by preventing childhood experiences (Anda, Chapman, Felitti, Edwards, Williamson, Croft and Giles, 2002). Another study related with this issue investigates the impact of adverse childhood experiences of females on adolescent pregnancy. It also explores long term psychosocial consequences and. The participants were 9159 women older from who attended a primary care clinic in San Diego, California in 1995–1997. The adverse childhood experience was scored by Adverse Childhood Experience Study questionnaire which investigates verbal, physical, and sexual abuse, battered mother, household substance abuse, mental illness in household, parental separation and divorce and criminal household members. In the study, it was found that there is a strong relationship between adverse childhood experiences and teen pregnancy. In addition, the association between adverse childhood experiences and the risk for fetal death after the first and second pregnancies was found by the study. However, no relationship was found between adolescent pregnancy and long-term psychosocial consequences such as high stress, anger, problems with their families, jobs and finances) (Hillis, Anda, Dube, Felitti, Marchbanks and Marks, 2004). The other study on this issue investigates the reason(s) for national declines in teen pregnancy and birthrates in US. It is realized that there has been a decrease from 51% to 43% in sexual experience among young women in high school between 1991 and 2001. The study aimed to explore the reason behind this issue. The data was elicited from public databases and the National Youth Risk Behavior Survey. The results revealed that the decrease in teen pregnancy in the last decade is due to delayed initiation of sexual intercourse, improved contraceptive practice, increasing condom use and decreasing use of withdrawal as a method (Santelli, Abma, Ventura, Lindberg, Morrow, Anderson, Lyss, Hamilton, 2004). Another study about teen pregnancy investigates the relationship between unprotected sexual activity and teen pregnancy. For this aim, a 5-point Likert-type scale was applied to 572 women. In this measure, condom-use prevention beliefs, condom-use hedonistic beliefs, partner reaction beliefs and self-efficacy beliefs were included. The results of this study revealed that adolescents who are pregnant were engaged in unprotected sex and had little intention to use condoms. They were also less likely to have a steady partner, and ever have anal sex. All these results support that there is a relationship between teen pregnancy and unprotected sexual activity (Koniak-Griffin, Lesser, Uman, Nyamathi, 2003). A study was conducted in order to find out how sex ratios of different countries affect the reproduction of the women. The study consists of data from 42 nations and gives interesting findings about teenage pregnancy. In developed countries, teens generally give births without getting married, whereas in less developed countries teen get married at a lower age. The analysis of the data shows that urbanization declines the rate of teenage pregnancies. However studies still suggests that both parts of teens, even married or not, have social problems when they got pregnant. The study further suggests that if there are not enough marriageable men, teen pregnancy increases. The possible reason under the finding may be that women do not pursue the high status men and delay the reproduction when there are fewer men than women (Barber, 2000). In order to understand the role of men and abuse on teen pregnancy, a study was conducted on more than 4000 men by analyzing the answers on a questionnaire (Anda, Felitti, Chapman, Croft, Williamson, Santelli, Dietz & Marks, 2001). The results show that both girls and boys who are abused are more likely to have multiple sexual partners and begin having intercourse earlier than peers. This finding shows that abuse is an important risk factor in teenage pregnancy, because having sex earlier increase the girls to get pregnant earlier. There is another risk factor that couples with early sexual relationship, which is drinking alcohol before the intercourse. The findings further suggest that the men that have a history of sexual or physical abuse are two times more likely to impregnate a teen girl. As a suggestion, this study shows the importance of controlling abuse in order to prevent teenage pregnancy. Other possible characteristics of men that are more probable to impregnate a teen girl are that they have low achievement in the school, drug abusers, they have problems in family. Further results of this study suggest that since teenage mothering is stressing and enduring, the children of teen mother are more likely to be abused. In addition, these children are more likely to engage in sexual relationship in adolescence which increases the teen pregnancy risk again. This situation makes it possible to maintain the cycle of teen pregnancy (Anda et.al., 2001). Comprehensive research about adolescent pregnancy in Turkey is inadequate. When research about teenage pregnancy in Turkey is analyzed, it can be seen that most of the research are either literature review or very specific to some locations. One of the studies that analyze the adolescent pregnancy in the district Denizli, cited in its discussion that that teenage pregnancy is more popular in extended families and unemployed teenage girls are more likely to get pregnant. The study also supported the previous studies that exposing to violence in childhood predicts adolescent pregnancy later. The analysis of the subjects of this study also shows that the percentage of the adolescent pregnant subjects is married at about 90%. This shows the adolescent marriages account much more than getting pregnant outside the marriage in this sample (Gökçe, Özşahin &Zencir, 2007). Another study that was conducted in İzmir showed that the adolescence pregnant women are more likely to be uneducated, unemployed and are not officially married, rather they are religiously married and from the Eastern part of Turkey. The other finding also revealed that the low birth weight is associated with teenage mothering (Keskinoğlu, Bilgic, Picakciefe, Giray, Karakus & Gunay, 2007). Overall, the research suggested the relationship between adolescent pregnancy and SES, employment level and education level.
There is a study that evaluates the effectiveness of an education program, Safer Choices that is developed to reduce sexual risk behavior and to teach protective behaviors. The study focuses on the sexually transmitted disease and unintended pregnancy among teenage groups. It is stated that approximately 10% of girls whose ages between 15 and 19 get pregnant each year (Coyle, Basen-Engquist, Kirby, Parcel, Parcel, Colins, Baumler, Carnajal & Harrist, 2001). The hypothesis is that teens who receive Safer Choices education program are more careful about sexual intercourse. The research was done in 20 public schools as randomly assigned to comparison and intervention groups. The participants are 3869 ninth grade students were surveyed at 31-month follow-up. The survey aimed at measuring three behavioral outcome; whether students delayed initiation of sexual intercourse; the number of times students had intercourse without a condom in the last three months; and the number of sexual partners with whom students had intercourse without a condom in the last three months. It is concluded that the education program had a positive and greater impact on adolescents’ sexual behaviors. They reported that they use condom, birth control pills and other protection methods. In the American society, there are social norms that support sexual activity, so focusing on the ‘not to have sex’ may not be helpful. It is the basic point that differs Safer Choices from the other sexually educative programs.

FUTURE QUESTIONS
Since there is very limited research in Turkey on teenage pregnancy, conducyting any further research is recommended. Specifically, existing research are limited to certain locations, so further national research is vital. Although teenage pregnancy is not considered as an important problem in Turkey, it should be regarded as a growing problem and should be taken into consideration in future research. In these future research, following questions can be adressed; * What are the relationship between teenage pregnancy and SES? * Do teens who live in poverty or unemployed have higher rates of pregnancy? * Do teen in low SES get pregnant due to early marriages or extramaritial pregnancy? * Is there an association between high rate of teenage pregnancy and early marriages? * How cultural values of Turkey affect teenage pregnancy? * Is there a significant difference among pregnant teens in terms of their ethnical background? * Is there a regional differences in the rates of teen pregnancy? * Does parenting style have a siginificant impact on teenage pregnancy? * How adverse childhood experiences such as abuse, divorced parents and addicted parents affect teenage pregnancy? * To what percentage of teen marriages are involuntary? * To what percentage of teen pregnancies are resulted from rape or incest? * Does an efficient sexual education programmencontribute to decrease in the rate of teenage pregnancy? * Is there a summative evaluation for these preogrammes?

References
Anda, R. F., Chapman, D. P., Felitti, V. J., Edwards, V., Williamson, D. F., Croft, J. B. and Dietz, P. M. and Marks, J. S., (2001), Abused Boys, Battered Mothers, and Male Involvement in Teen Pregnancy, Pediatrics; 107; e19.

Anda, R. F., Chapman, D. P., Felitti, V. J., Edwards, V., Williamson, D. F., Croft, J. B. and Giles, W. H., (2002), Adverse Childhood Experiences and Risk of Paternity in Teen Pregnancy, Obstetrics & Gynecology.

Barber, N., (2000), On the Relationship between Country Sex Ratios and Teen Pregnancy Rates: A Replication, Cross-Cultural Research 34: 26.

Coyle, K., Basen-Engquist, B., Kirby, D., Parcel G., S., Banspach, Collins, J., Baumler, E., Carvajal, S. and Harrist, S., (2001), Safer Choices: Reducing Teen
Pregnancy, HIV, and STDs, Public Health Reports, Supplement 1, Volume 116.

Gökce, B., Ozsahin, A. and Zencir, M., (2007), Determinants of Adolescent
Pregnancy in An Urban Area in Turkey: a population-based case-control study, J.biosoc.Sci, 39, 301–311.

Hillis, S. D., Anda, R. F., Dube S. R., Felitti V. J., Marchbanks, P.A. and Marks, J. S., (2004), The Association Between Adverse Childhood Experiences and Adolescent Pregnancy, Long-Term Psychosocial Consequences, and Fetal Death, Pediatrics;113;320-327.

Keskinoglu, P., Bilgic, N., Picakciefe, M., Giray H., Karakus, N. and Gunay, T., (2007), Perinatal Outcomes and Risk Factors of Turkish Adolescent Mothers, J Pediatr Adolesc Gynecol 20:19e24.

Koniak-Griffin, D., Lesser, J., Uman, G., and Nyamathi, A., (2003), Teen Pregnancy, Motherhood, and Unprotected Sexual Activity, Research in Nursing & Health, 26, 4–19.
Mason, K., 2011, Teenage Pregnancy, InnovAiT, Vol. 4, No. 3, pp. 123–129.

Santelli J. S., Abma J., Ventura S., Lindberg, L., Morrow B., Anderson, J. E, Lyss, S. And Hamilton B. E., (2004), Can Changes in Sexual Behaviors Among High School Students Explain the Decline in Teen Pregnancy Rates in the 1990s?, Journal of Adolescent Health; 35:80–90.

Yücel, C., (2003), Çağcıl Bir Eğitim Problemi: Ergen Gebeliği, Sosyal Bilimler Dergisi, Afyon Kocatepe Üniversitesi, 5(2), 81-88.

References: Anda, R. F., Chapman, D. P., Felitti, V. J., Edwards, V., Williamson, D. F., Croft, J. B. and Dietz, P. M. and Marks, J. S., (2001), Abused Boys, Battered Mothers, and Male Involvement in Teen Pregnancy, Pediatrics; 107; e19. Anda, R. F., Chapman, D. P., Felitti, V. J., Edwards, V., Williamson, D. F., Croft, J. B. and Giles, W. H., (2002), Adverse Childhood Experiences and Risk of Paternity in Teen Pregnancy, Obstetrics & Gynecology. Barber, N., (2000), On the Relationship between Country Sex Ratios and Teen Pregnancy Rates: A Replication, Cross-Cultural Research 34: 26. Coyle, K., Basen-Engquist, B., Kirby, D., Parcel G., S., Banspach, Collins, J., Baumler, E., Carvajal, S. and Harrist, S., (2001), Safer Choices: Reducing Teen Pregnancy, HIV, and STDs, Public Health Reports, Supplement 1, Volume 116. Gökce, B., Ozsahin, A. and Zencir, M., (2007), Determinants of Adolescent Pregnancy in An Urban Area in Turkey: a population-based case-control study, J.biosoc.Sci, 39, 301–311. Hillis, S. D., Anda, R. F., Dube S. R., Felitti V. J., Marchbanks, P.A. and Marks, J. S., (2004), The Association Between Adverse Childhood Experiences and Adolescent Pregnancy, Long-Term Psychosocial Consequences, and Fetal Death, Pediatrics;113;320-327. Keskinoglu, P., Bilgic, N., Picakciefe, M., Giray H., Karakus, N. and Gunay, T., (2007), Perinatal Outcomes and Risk Factors of Turkish Adolescent Mothers, J Pediatr Adolesc Gynecol 20:19e24. Koniak-Griffin, D., Lesser, J., Uman, G., and Nyamathi, A., (2003), Teen Pregnancy, Motherhood, and Unprotected Sexual Activity, Research in Nursing & Health, 26, 4–19. Mason, K., 2011, Teenage Pregnancy, InnovAiT, Vol. 4, No. 3, pp. 123–129.