Adolescent Girls’ Attitudes Toward Pregnancy: The Importance of Asking What the Boyfriend Wants

Early adolescent childbearing is associated with a wide range of adverse consequences and restricted life opportunities for young girls and the children they bear.^1-5 Helping adolescents delay early childbearing has long been a goal of healthcare providers, researchers, and policymakers.^6,7 Although the adolescent pregnancy rate in the United States is decreasing in most groups,⁸ it is still disturbingly high, particularly among Hispanic girls.

Most efforts to prevent or delay adolescent pregnancy have been directed at providing birth control, but this intervention is likely to fail if teens are not interested in preventing pregnancy. Although several studies have examined the factors and motivations underlying adolescent contraceptive behavior,^9-13 teen attitudes toward pregnancy are still poorly understood.¹⁴ Adolescents may not share the same negative view of their childbearing as do adults concerned with preventing it. Retrospective studies suggest that as many as 60% to 80% of teenaged pregnancies are “unintended.”^15,16 Other studies examining pregnant and parenting adolescents’ attitudes toward childbearing suggest that the percentage of pregnancies that are truly unintended may be lower than commonly believed.^10,17-19 A significant percentage of never-pregnant adolescents harbor either highly ambivalent or positive attitudes toward early childbearing.^19-21 A better understanding of the factors associated with a desire for pregnancy among adolescents may help health care providers better predict the most at-risk adolescents.

Our study investigated factors associated with adolescent desire for pregnancy among girls seeking reproductive health services at an adolescent clinic. Earlier studies have examined the attitudes of girls presenting for pregnancy testing, or who were already enrolled in prenatal care.⁹ No other studies have specifically looked at the factors associated with nonpregnant adolescents’ attitudes toward pregnancy, or the role of the boyfriend in influencing those attitudes.

Methods

Setting

This study was conducted in an adolescent health clinic within a migrant/community health center in a town with a population of 10,000, 25 miles from a major midwestern city. The clinic was staffed by a nurse practitioner and an adolescent health educator. The full spectrum of adolescent problems are dealt with in this clinic, but most visits are for pregnancy testing, birth control counseling, and checks for sexually transmitted diseases (STDs). Ninety-eight percent of visits are by females. The clinic serves patients aged 12 through 20 years, and has been operating in its current location for 20 years. The clinic offers completely confidential services to those who request it, with no parental notification or consent required.

Subjects

Girls aged 13 to18 years presenting consecutively for reproductive health services were eligible for this study. Girls were excluded if they had delivered a baby in the previous 12 months, had a miscarriage or a therapeutic abortion in the previous 6 months, or were currently using a hormonal method of contraception. A total of 202 girls were initially eligible and all agreed to participate. Because studies have shown that a woman’s attitude toward pregnancy changes once she is aware of being pregnant, we subsequently decided to also exclude those girls already pregnant at the initial visit (n=54), leaving 148 subjects in the final data analysis. All subjects spoke either Spanish or English.

Data Collection

After obtaining informed consent, each girl underwent an extensive, semistructured interview exploring her attitude toward pregnancy, childbearing, and contraceptive use. All interviews were done by 1 of the 2 clinicians working in the adolescent clinic (a 35-year-old adolescent health educator and a 40-year-old obstetric nurse practitioner). Both clinicians were white women who had been working in this clinic for more than 15 years. The health educator was fluent in Spanish. A girl’s attitude toward pregnancy was determined by a series of questions. Other information elicited included ethnicity, age, school attendance, employment status, social habits (alcohol and tobacco use, current dating, current sexual activity), family structure, whether the subject had ever lived away from home for more than 2 weeks, age of her boyfriend, boyfriend’s attitude about pregnancy, and confidentiality of the initial visit. Obstetric and gynecologic histories of each girl were also obtained. After the interview, pregnancy testing was done, if indicated.

Data Analysis

Based on the interview, each girl was categorized as desiring pregnancy, wishing to avoid pregnancy, or being ambivalent about pregnancy. Girls desiring pregnancy were so similar to girls who felt ambivalent about pregnancy that these girls were grouped together in the final analysis and compared against those girls wishing to avoid pregnancy.

Data were analyzed using the SAS statistical program (version 8.0). We used chi-squared testing for unadjusted analysis of factors associated with adolescent attitudes toward pregnancy. Unadjusted associations with a P value greater than .2 were included in multiple logistic regression analysis to adjust for multiple variables, and to calculate odds ratios and 95% confidence intervals. The final multiple logistic regression model included only those variables found to retain significance at P less than .05.

Results

Demographic characteristics of the participants are shown in Table 1. Of the 148 girls, almost all (92%) were currently dating, and most (88%) were sexually active with their partner. Ninety-six percent had never been pregnant previously, 86% had never used hormonal contraception, and 84% had never had a Papanicolaou test or an STD screening.

The mean age of subjects’ boyfriends was 18.4 years, with an age range of 13 to 30 years. One third of the girls lived with both of their biological parents, and 78% lived with at least one biological parent. Three were already married at the time of initial visit. Almost half (46%) described their enrollment visit as confidential.

One hundred seven (56.4%) of the girls were categorized as wishing to avoid pregnancy, 16 girls (19.8%) as desiring pregnancy, and 25 girls (23.7%) as ambivalent about whether they wanted to be pregnant. Unadjusted analysis comparing girls desiring pregnancy with those feeling ambivalent revealed only 1 significant difference: girls desiring pregnancy were more likely to report that their boyfriends wanted a baby. So, in the final analysis, these girls were grouped together, and compared with the girls wishing to avoid pregnancy (Table 1w.

Unadjusted analysis of the 148 subjects is shown in Table 2. Girls wishing to avoid pregnancy differed from girls desiring or ambivalent about pregnancy in 6 different parameters: ethnicity, school attendance, employment status, family structure, time spent away from home, and desire of boyfriend to have a baby. There was no significant association between a girl’s age and her attitude toward pregnancy (P=.48). Notably, the mean age difference between girls and their boyfriends was not significantly associated with desire for pregnancy.

In multivariate analysis of characteristics of the girls themselves, factors significantly associated with a positive attitude toward pregnancy were Hispanic ethnicity, having lived away from home for more than 2 weeks, and having left school Table 3.

When boyfriend characteristics and attitudes were added to the analysis, all subject characteristics ceased to be significant, leaving the perception of the boyfriends’ desire for pregnancy as the only significant variable.

Discussion

We found the strongest predictor of an adolescent girl’s attitude toward pregnancy was her stated belief about whether her boyfriend wanted a baby. In light of the powerful influence of the girl’s perception of her boyfriend’s attitude toward pregnancy, no other factors are significantly associated with her own attitude toward pregnancy. This finding suggests that family physicians and other health care providers working with teenaged girls should include the boyfriend in any discussions aimed at delaying pregnancy.

Girls ambivalent about pregnancy are markedly similar to those desiring it, differing only in the degree to which they believe their boyfriends want a baby. It may be that some of the ambivalence about pregnancy arises from a difference of opinion between the girl and her boyfriend. Girls ambivalent about pregnancy were least likely to know their boyfriend’s opinion on the subject. It may be that young girls who are ambivalent about pregnancy are also those with more limited interpersonal communication skills, making it difficult for them to discuss critical reproductive health issues with their partners. Health care providers may have a role in facilitating improved communication between girls and their partners by specifically addressing partner communication when seeing girls individually, as well as by inviting their partners to be present and more actively involved in clinic visits. Interventions focused solely on providing information about and access to contraception are unlikely to be sufficient in strengthening a girl’s motivation to delay pregnancy. More appropriate and effective interventions may be those that explore the extent to which her partner’s attitudes shape her own critical reproductive health decisions, and encourage greater dialogue between a girl and her partner with respect to contraceptive and childbearing decisions.

Although several studies have been done on the contraceptive behavior of adolescent girls, to our knowledge no other studies have focused on evaluating the influence of the boyfriend’s perceived attitude toward childbearing on nonpregnant adolescent girls’ desire for a child. Our study did not support other studies’ findings showing that girls desiring pregnancy are more likely to have older boyfriends.²² In our study population, neither boyfriend age nor the age difference between the girl and her boyfriend were significantly associated with the girl’s desire to become pregnant.

Limitations

Our study has several limitations. We did not talk with the boyfriends themselves, but instead were limited to what the girls reported about their boyfriends. The girls’ perceptions of their boyfriends’ attitudes toward pregnancy may be more a reflection of the girls’ own desires. Also, we do not know what the girls really thought about pregnancy, only what they reported to us. It may be that more girls desired pregnancy, but were not willing to admit it. Our study did not use a previously validated questionnaire to determine “intendedness” of pregnancy. Because of the difficulty in ascribing motivations to adolescent behavior and reported attitudes, the entire concept of intendedness of pregnancy may not be relevant when discussing adolescent pregnancies.^18,23 However, the semistructured interview used in our study elicited a rich and detailed explanation of attitudes toward such topics as birth control, pregnancy, and influences of family and boyfriend.

Our study results may not be generalizable to other adolescent populations. Our study sample was from a mostly rural area, and the only minority group represented was Hispanic. The vast majority of girls visiting our community health center are from low socioeconomic groups. It is not clear that our results would be true for other ethnicities or for girls from higher socioeconomic levels.

Conclusions

A boyfriend’s desire for a baby is best predictor of an adolescent girl’s attitude toward pregnancy. The most effective interventions may be those that explore the extent to which a boyfriend’s attitude shapes a girl’s critical reproductive health decisions. Primary care providers should include boyfriends in any efforts to delay pregnancy in at-risk adolescent girls and should encourage greater dialogue between the girl and her partner with respect to contraceptive and childbearing decisions.

Acknowledgments

The authors would like to acknowledge the following people for their assistance with this study: Kathy Beamis, for help with data collection; Sherry Holcomb, MS, and Debbi Main, PhD, for help with data analysis; the University of Colorado Primary Care Faculty Development Fellowship group, for review and suggestions.

Related resources

• National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org
• National Organization on Adolescent Pregnancy, Parenting, and Prevention http://www.noappp.org
• The Alan Guttmacher Institute Nonprofit organization focused on reproductive health research, policy analysis and public education. http://www.agi-usa.org
• Advocates for Youth Programs designed to help young people make informed decisions about reproductive and sexual health. http://advocatesforyouth.org

Early adolescent childbearing is associated with a wide range of adverse consequences and restricted life opportunities for young girls and the children they bear.^1-5 Helping adolescents delay early childbearing has long been a goal of healthcare providers, researchers, and policymakers.^6,7 Although the adolescent pregnancy rate in the United States is decreasing in most groups,⁸ it is still disturbingly high, particularly among Hispanic girls.

Most efforts to prevent or delay adolescent pregnancy have been directed at providing birth control, but this intervention is likely to fail if teens are not interested in preventing pregnancy. Although several studies have examined the factors and motivations underlying adolescent contraceptive behavior,^9-13 teen attitudes toward pregnancy are still poorly understood.¹⁴ Adolescents may not share the same negative view of their childbearing as do adults concerned with preventing it. Retrospective studies suggest that as many as 60% to 80% of teenaged pregnancies are “unintended.”^15,16 Other studies examining pregnant and parenting adolescents’ attitudes toward childbearing suggest that the percentage of pregnancies that are truly unintended may be lower than commonly believed.^10,17-19 A significant percentage of never-pregnant adolescents harbor either highly ambivalent or positive attitudes toward early childbearing.^19-21 A better understanding of the factors associated with a desire for pregnancy among adolescents may help health care providers better predict the most at-risk adolescents.

Our study investigated factors associated with adolescent desire for pregnancy among girls seeking reproductive health services at an adolescent clinic. Earlier studies have examined the attitudes of girls presenting for pregnancy testing, or who were already enrolled in prenatal care.⁹ No other studies have specifically looked at the factors associated with nonpregnant adolescents’ attitudes toward pregnancy, or the role of the boyfriend in influencing those attitudes.

Methods

Setting

This study was conducted in an adolescent health clinic within a migrant/community health center in a town with a population of 10,000, 25 miles from a major midwestern city. The clinic was staffed by a nurse practitioner and an adolescent health educator. The full spectrum of adolescent problems are dealt with in this clinic, but most visits are for pregnancy testing, birth control counseling, and checks for sexually transmitted diseases (STDs). Ninety-eight percent of visits are by females. The clinic serves patients aged 12 through 20 years, and has been operating in its current location for 20 years. The clinic offers completely confidential services to those who request it, with no parental notification or consent required.

Subjects

Girls aged 13 to18 years presenting consecutively for reproductive health services were eligible for this study. Girls were excluded if they had delivered a baby in the previous 12 months, had a miscarriage or a therapeutic abortion in the previous 6 months, or were currently using a hormonal method of contraception. A total of 202 girls were initially eligible and all agreed to participate. Because studies have shown that a woman’s attitude toward pregnancy changes once she is aware of being pregnant, we subsequently decided to also exclude those girls already pregnant at the initial visit (n=54), leaving 148 subjects in the final data analysis. All subjects spoke either Spanish or English.

Data Collection

After obtaining informed consent, each girl underwent an extensive, semistructured interview exploring her attitude toward pregnancy, childbearing, and contraceptive use. All interviews were done by 1 of the 2 clinicians working in the adolescent clinic (a 35-year-old adolescent health educator and a 40-year-old obstetric nurse practitioner). Both clinicians were white women who had been working in this clinic for more than 15 years. The health educator was fluent in Spanish. A girl’s attitude toward pregnancy was determined by a series of questions. Other information elicited included ethnicity, age, school attendance, employment status, social habits (alcohol and tobacco use, current dating, current sexual activity), family structure, whether the subject had ever lived away from home for more than 2 weeks, age of her boyfriend, boyfriend’s attitude about pregnancy, and confidentiality of the initial visit. Obstetric and gynecologic histories of each girl were also obtained. After the interview, pregnancy testing was done, if indicated.

Data Analysis

Based on the interview, each girl was categorized as desiring pregnancy, wishing to avoid pregnancy, or being ambivalent about pregnancy. Girls desiring pregnancy were so similar to girls who felt ambivalent about pregnancy that these girls were grouped together in the final analysis and compared against those girls wishing to avoid pregnancy.

Data were analyzed using the SAS statistical program (version 8.0). We used chi-squared testing for unadjusted analysis of factors associated with adolescent attitudes toward pregnancy. Unadjusted associations with a P value greater than .2 were included in multiple logistic regression analysis to adjust for multiple variables, and to calculate odds ratios and 95% confidence intervals. The final multiple logistic regression model included only those variables found to retain significance at P less than .05.

Results

Demographic characteristics of the participants are shown in Table 1. Of the 148 girls, almost all (92%) were currently dating, and most (88%) were sexually active with their partner. Ninety-six percent had never been pregnant previously, 86% had never used hormonal contraception, and 84% had never had a Papanicolaou test or an STD screening.

The mean age of subjects’ boyfriends was 18.4 years, with an age range of 13 to 30 years. One third of the girls lived with both of their biological parents, and 78% lived with at least one biological parent. Three were already married at the time of initial visit. Almost half (46%) described their enrollment visit as confidential.

One hundred seven (56.4%) of the girls were categorized as wishing to avoid pregnancy, 16 girls (19.8%) as desiring pregnancy, and 25 girls (23.7%) as ambivalent about whether they wanted to be pregnant. Unadjusted analysis comparing girls desiring pregnancy with those feeling ambivalent revealed only 1 significant difference: girls desiring pregnancy were more likely to report that their boyfriends wanted a baby. So, in the final analysis, these girls were grouped together, and compared with the girls wishing to avoid pregnancy (Table 1w.

Unadjusted analysis of the 148 subjects is shown in Table 2. Girls wishing to avoid pregnancy differed from girls desiring or ambivalent about pregnancy in 6 different parameters: ethnicity, school attendance, employment status, family structure, time spent away from home, and desire of boyfriend to have a baby. There was no significant association between a girl’s age and her attitude toward pregnancy (P=.48). Notably, the mean age difference between girls and their boyfriends was not significantly associated with desire for pregnancy.

In multivariate analysis of characteristics of the girls themselves, factors significantly associated with a positive attitude toward pregnancy were Hispanic ethnicity, having lived away from home for more than 2 weeks, and having left school Table 3.

When boyfriend characteristics and attitudes were added to the analysis, all subject characteristics ceased to be significant, leaving the perception of the boyfriends’ desire for pregnancy as the only significant variable.

Discussion

We found the strongest predictor of an adolescent girl’s attitude toward pregnancy was her stated belief about whether her boyfriend wanted a baby. In light of the powerful influence of the girl’s perception of her boyfriend’s attitude toward pregnancy, no other factors are significantly associated with her own attitude toward pregnancy. This finding suggests that family physicians and other health care providers working with teenaged girls should include the boyfriend in any discussions aimed at delaying pregnancy.

Girls ambivalent about pregnancy are markedly similar to those desiring it, differing only in the degree to which they believe their boyfriends want a baby. It may be that some of the ambivalence about pregnancy arises from a difference of opinion between the girl and her boyfriend. Girls ambivalent about pregnancy were least likely to know their boyfriend’s opinion on the subject. It may be that young girls who are ambivalent about pregnancy are also those with more limited interpersonal communication skills, making it difficult for them to discuss critical reproductive health issues with their partners. Health care providers may have a role in facilitating improved communication between girls and their partners by specifically addressing partner communication when seeing girls individually, as well as by inviting their partners to be present and more actively involved in clinic visits. Interventions focused solely on providing information about and access to contraception are unlikely to be sufficient in strengthening a girl’s motivation to delay pregnancy. More appropriate and effective interventions may be those that explore the extent to which her partner’s attitudes shape her own critical reproductive health decisions, and encourage greater dialogue between a girl and her partner with respect to contraceptive and childbearing decisions.

Although several studies have been done on the contraceptive behavior of adolescent girls, to our knowledge no other studies have focused on evaluating the influence of the boyfriend’s perceived attitude toward childbearing on nonpregnant adolescent girls’ desire for a child. Our study did not support other studies’ findings showing that girls desiring pregnancy are more likely to have older boyfriends.²² In our study population, neither boyfriend age nor the age difference between the girl and her boyfriend were significantly associated with the girl’s desire to become pregnant.

Limitations

Our study has several limitations. We did not talk with the boyfriends themselves, but instead were limited to what the girls reported about their boyfriends. The girls’ perceptions of their boyfriends’ attitudes toward pregnancy may be more a reflection of the girls’ own desires. Also, we do not know what the girls really thought about pregnancy, only what they reported to us. It may be that more girls desired pregnancy, but were not willing to admit it. Our study did not use a previously validated questionnaire to determine “intendedness” of pregnancy. Because of the difficulty in ascribing motivations to adolescent behavior and reported attitudes, the entire concept of intendedness of pregnancy may not be relevant when discussing adolescent pregnancies.^18,23 However, the semistructured interview used in our study elicited a rich and detailed explanation of attitudes toward such topics as birth control, pregnancy, and influences of family and boyfriend.

Our study results may not be generalizable to other adolescent populations. Our study sample was from a mostly rural area, and the only minority group represented was Hispanic. The vast majority of girls visiting our community health center are from low socioeconomic groups. It is not clear that our results would be true for other ethnicities or for girls from higher socioeconomic levels.

Conclusions

A boyfriend’s desire for a baby is best predictor of an adolescent girl’s attitude toward pregnancy. The most effective interventions may be those that explore the extent to which a boyfriend’s attitude shapes a girl’s critical reproductive health decisions. Primary care providers should include boyfriends in any efforts to delay pregnancy in at-risk adolescent girls and should encourage greater dialogue between the girl and her partner with respect to contraceptive and childbearing decisions.

Acknowledgments

The authors would like to acknowledge the following people for their assistance with this study: Kathy Beamis, for help with data collection; Sherry Holcomb, MS, and Debbi Main, PhD, for help with data analysis; the University of Colorado Primary Care Faculty Development Fellowship group, for review and suggestions.

Related resources

• National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org
• National Organization on Adolescent Pregnancy, Parenting, and Prevention http://www.noappp.org
• The Alan Guttmacher Institute Nonprofit organization focused on reproductive health research, policy analysis and public education. http://www.agi-usa.org
• Advocates for Youth Programs designed to help young people make informed decisions about reproductive and sexual health. http://advocatesforyouth.org

Early adolescent childbearing is associated with a wide range of adverse consequences and restricted life opportunities for young girls and the children they bear.^1-5 Helping adolescents delay early childbearing has long been a goal of healthcare providers, researchers, and policymakers.^6,7 Although the adolescent pregnancy rate in the United States is decreasing in most groups,⁸ it is still disturbingly high, particularly among Hispanic girls.

Most efforts to prevent or delay adolescent pregnancy have been directed at providing birth control, but this intervention is likely to fail if teens are not interested in preventing pregnancy. Although several studies have examined the factors and motivations underlying adolescent contraceptive behavior,^9-13 teen attitudes toward pregnancy are still poorly understood.¹⁴ Adolescents may not share the same negative view of their childbearing as do adults concerned with preventing it. Retrospective studies suggest that as many as 60% to 80% of teenaged pregnancies are “unintended.”^15,16 Other studies examining pregnant and parenting adolescents’ attitudes toward childbearing suggest that the percentage of pregnancies that are truly unintended may be lower than commonly believed.^10,17-19 A significant percentage of never-pregnant adolescents harbor either highly ambivalent or positive attitudes toward early childbearing.^19-21 A better understanding of the factors associated with a desire for pregnancy among adolescents may help health care providers better predict the most at-risk adolescents.

Our study investigated factors associated with adolescent desire for pregnancy among girls seeking reproductive health services at an adolescent clinic. Earlier studies have examined the attitudes of girls presenting for pregnancy testing, or who were already enrolled in prenatal care.⁹ No other studies have specifically looked at the factors associated with nonpregnant adolescents’ attitudes toward pregnancy, or the role of the boyfriend in influencing those attitudes.

Methods

Setting

This study was conducted in an adolescent health clinic within a migrant/community health center in a town with a population of 10,000, 25 miles from a major midwestern city. The clinic was staffed by a nurse practitioner and an adolescent health educator. The full spectrum of adolescent problems are dealt with in this clinic, but most visits are for pregnancy testing, birth control counseling, and checks for sexually transmitted diseases (STDs). Ninety-eight percent of visits are by females. The clinic serves patients aged 12 through 20 years, and has been operating in its current location for 20 years. The clinic offers completely confidential services to those who request it, with no parental notification or consent required.

Subjects

Girls aged 13 to18 years presenting consecutively for reproductive health services were eligible for this study. Girls were excluded if they had delivered a baby in the previous 12 months, had a miscarriage or a therapeutic abortion in the previous 6 months, or were currently using a hormonal method of contraception. A total of 202 girls were initially eligible and all agreed to participate. Because studies have shown that a woman’s attitude toward pregnancy changes once she is aware of being pregnant, we subsequently decided to also exclude those girls already pregnant at the initial visit (n=54), leaving 148 subjects in the final data analysis. All subjects spoke either Spanish or English.

Data Collection

After obtaining informed consent, each girl underwent an extensive, semistructured interview exploring her attitude toward pregnancy, childbearing, and contraceptive use. All interviews were done by 1 of the 2 clinicians working in the adolescent clinic (a 35-year-old adolescent health educator and a 40-year-old obstetric nurse practitioner). Both clinicians were white women who had been working in this clinic for more than 15 years. The health educator was fluent in Spanish. A girl’s attitude toward pregnancy was determined by a series of questions. Other information elicited included ethnicity, age, school attendance, employment status, social habits (alcohol and tobacco use, current dating, current sexual activity), family structure, whether the subject had ever lived away from home for more than 2 weeks, age of her boyfriend, boyfriend’s attitude about pregnancy, and confidentiality of the initial visit. Obstetric and gynecologic histories of each girl were also obtained. After the interview, pregnancy testing was done, if indicated.

Data Analysis

Based on the interview, each girl was categorized as desiring pregnancy, wishing to avoid pregnancy, or being ambivalent about pregnancy. Girls desiring pregnancy were so similar to girls who felt ambivalent about pregnancy that these girls were grouped together in the final analysis and compared against those girls wishing to avoid pregnancy.

Data were analyzed using the SAS statistical program (version 8.0). We used chi-squared testing for unadjusted analysis of factors associated with adolescent attitudes toward pregnancy. Unadjusted associations with a P value greater than .2 were included in multiple logistic regression analysis to adjust for multiple variables, and to calculate odds ratios and 95% confidence intervals. The final multiple logistic regression model included only those variables found to retain significance at P less than .05.

Results

Demographic characteristics of the participants are shown in Table 1. Of the 148 girls, almost all (92%) were currently dating, and most (88%) were sexually active with their partner. Ninety-six percent had never been pregnant previously, 86% had never used hormonal contraception, and 84% had never had a Papanicolaou test or an STD screening.

The mean age of subjects’ boyfriends was 18.4 years, with an age range of 13 to 30 years. One third of the girls lived with both of their biological parents, and 78% lived with at least one biological parent. Three were already married at the time of initial visit. Almost half (46%) described their enrollment visit as confidential.

One hundred seven (56.4%) of the girls were categorized as wishing to avoid pregnancy, 16 girls (19.8%) as desiring pregnancy, and 25 girls (23.7%) as ambivalent about whether they wanted to be pregnant. Unadjusted analysis comparing girls desiring pregnancy with those feeling ambivalent revealed only 1 significant difference: girls desiring pregnancy were more likely to report that their boyfriends wanted a baby. So, in the final analysis, these girls were grouped together, and compared with the girls wishing to avoid pregnancy (Table 1w.

Unadjusted analysis of the 148 subjects is shown in Table 2. Girls wishing to avoid pregnancy differed from girls desiring or ambivalent about pregnancy in 6 different parameters: ethnicity, school attendance, employment status, family structure, time spent away from home, and desire of boyfriend to have a baby. There was no significant association between a girl’s age and her attitude toward pregnancy (P=.48). Notably, the mean age difference between girls and their boyfriends was not significantly associated with desire for pregnancy.

In multivariate analysis of characteristics of the girls themselves, factors significantly associated with a positive attitude toward pregnancy were Hispanic ethnicity, having lived away from home for more than 2 weeks, and having left school Table 3.

When boyfriend characteristics and attitudes were added to the analysis, all subject characteristics ceased to be significant, leaving the perception of the boyfriends’ desire for pregnancy as the only significant variable.

Discussion

We found the strongest predictor of an adolescent girl’s attitude toward pregnancy was her stated belief about whether her boyfriend wanted a baby. In light of the powerful influence of the girl’s perception of her boyfriend’s attitude toward pregnancy, no other factors are significantly associated with her own attitude toward pregnancy. This finding suggests that family physicians and other health care providers working with teenaged girls should include the boyfriend in any discussions aimed at delaying pregnancy.

Girls ambivalent about pregnancy are markedly similar to those desiring it, differing only in the degree to which they believe their boyfriends want a baby. It may be that some of the ambivalence about pregnancy arises from a difference of opinion between the girl and her boyfriend. Girls ambivalent about pregnancy were least likely to know their boyfriend’s opinion on the subject. It may be that young girls who are ambivalent about pregnancy are also those with more limited interpersonal communication skills, making it difficult for them to discuss critical reproductive health issues with their partners. Health care providers may have a role in facilitating improved communication between girls and their partners by specifically addressing partner communication when seeing girls individually, as well as by inviting their partners to be present and more actively involved in clinic visits. Interventions focused solely on providing information about and access to contraception are unlikely to be sufficient in strengthening a girl’s motivation to delay pregnancy. More appropriate and effective interventions may be those that explore the extent to which her partner’s attitudes shape her own critical reproductive health decisions, and encourage greater dialogue between a girl and her partner with respect to contraceptive and childbearing decisions.

Although several studies have been done on the contraceptive behavior of adolescent girls, to our knowledge no other studies have focused on evaluating the influence of the boyfriend’s perceived attitude toward childbearing on nonpregnant adolescent girls’ desire for a child. Our study did not support other studies’ findings showing that girls desiring pregnancy are more likely to have older boyfriends.²² In our study population, neither boyfriend age nor the age difference between the girl and her boyfriend were significantly associated with the girl’s desire to become pregnant.

Limitations

Our study has several limitations. We did not talk with the boyfriends themselves, but instead were limited to what the girls reported about their boyfriends. The girls’ perceptions of their boyfriends’ attitudes toward pregnancy may be more a reflection of the girls’ own desires. Also, we do not know what the girls really thought about pregnancy, only what they reported to us. It may be that more girls desired pregnancy, but were not willing to admit it. Our study did not use a previously validated questionnaire to determine “intendedness” of pregnancy. Because of the difficulty in ascribing motivations to adolescent behavior and reported attitudes, the entire concept of intendedness of pregnancy may not be relevant when discussing adolescent pregnancies.^18,23 However, the semistructured interview used in our study elicited a rich and detailed explanation of attitudes toward such topics as birth control, pregnancy, and influences of family and boyfriend.

Our study results may not be generalizable to other adolescent populations. Our study sample was from a mostly rural area, and the only minority group represented was Hispanic. The vast majority of girls visiting our community health center are from low socioeconomic groups. It is not clear that our results would be true for other ethnicities or for girls from higher socioeconomic levels.

Conclusions

A boyfriend’s desire for a baby is best predictor of an adolescent girl’s attitude toward pregnancy. The most effective interventions may be those that explore the extent to which a boyfriend’s attitude shapes a girl’s critical reproductive health decisions. Primary care providers should include boyfriends in any efforts to delay pregnancy in at-risk adolescent girls and should encourage greater dialogue between the girl and her partner with respect to contraceptive and childbearing decisions.

Acknowledgments

The authors would like to acknowledge the following people for their assistance with this study: Kathy Beamis, for help with data collection; Sherry Holcomb, MS, and Debbi Main, PhD, for help with data analysis; the University of Colorado Primary Care Faculty Development Fellowship group, for review and suggestions.

Related resources

• National Campaign to Prevent Teen Pregnancy http://www.teenpregnancy.org
• National Organization on Adolescent Pregnancy, Parenting, and Prevention http://www.noappp.org
• The Alan Guttmacher Institute Nonprofit organization focused on reproductive health research, policy analysis and public education. http://www.agi-usa.org
• Advocates for Youth Programs designed to help young people make informed decisions about reproductive and sexual health. http://advocatesforyouth.org