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Teen Pregnancy - Real Causes, Real Soutions
by Anne Neville
R.N., R.M., Dip. Past. Psych., Dip. Marriage & Family Therapy, C.P.C.,
Accredited Counsellor National Association of Loss & Grief, A.M.C.C.A.,
M.A.S.T.S.S.
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“Unwanted
pregnancies, the beginnings of sexual relationships in unsafe
settings and other difficulties experienced by vulnerable
teenagers often do not occur randomly but in the context of a
background that leaves them prone to some misfortune.” |
Unconscious factors underlying crisis pregnancy: depression, replacing a
loss, deprivation and hostility in childhood, uncertain femininity,
self-punishment.
Case studies.
Implications for sexuality education.
Over the course of a year, counsellors at Open Doors see around 2000
clients of varying ages. A large number of our clients fall into the
15-23 age bracket. This age group is usually involved in discovering who
they are as individuals, studying, building careers, forming
relationships and generally having fun. Indeed, they are in the process
of laying down the foundation for their adult lives.
One would suspect that a pregnancy would not be high on their list of
priorities and, indeed, this is generally the case. However, all too
often we find ourselves talking to young people who are in the position
of having to make difficult choices about an unplanned pregnancy.
This article looks at the deeper underlying issues that may contribute
to an unplanned pregnancy, evidence of which we certainly see in our
contact with the people we serve. We refer to this phenomenon as
Pregnancy Proneness i.e. a predisposition to a pregnancy that is neither
consciously desired or planned for.
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Adolescents at greater risk
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It is estimated that approximately 9,000 babies were born to teenage
mothers in Australia in 1994 (The Centre for Adolescent Health, 1995).
However, this in no way represents the true extent of the teenage
pregnancy rate, given the current availability of abortion.
Common wisdom has it that sex education and training in the use of
contraception is the logical solution to the problem of unwanted
pregnancies. However, the widespread application of these ideas has in
no way eliminated the problem. Its very failure shows that we are not
dealing with the mere mechanics of anatomy and physiology but with a
more complex psychological situation.
Adolescents are at a greater risk of crisis pregnancies because of
factors related to their psychological immaturity. This includes their
restricted decision making capacity. Combine this fact with the
adolescent’s endeavours to come to terms emotionally with the reality of
their newly acquired fertility and their search for identity and we have
a precarious situation.
Teenage clients presenting at Open Doors for a pregnancy test are
usually in a state of crisis. The possibility of an unplanned pregnancy
constitutes a very significant crisis - one which threatens to throw
current plans into disarray. The immediate problem (a pregnancy) may
seem to be the only problem, with little awareness of the deeper issues
which may underlie an unplanned pregnancy. It is these deeper underlying
problems that pre-dispose a woman or couple to the risk of an unplanned
pregnancy - hence the term pregnancy proneness.
It has been found that some women seem to have a tendency to conceive
more frequently than others in situations where they believe it is not
their intention to have a child. The teenager usually does not
deliberately decide to become pregnant, although there are instances
when this is the case. So, one might ask, what factors may pre-dispose
towards an unplanned pregnancy?
Raphael (1972) described a range of underlying issues leading to the
conception of a child at a time that seems inappropriate to the mother.
These include - depression, replacing a loss, deprivation and hostility
in childhood, uncertain femininity, and self-punishment.
Here at Open Doors we often see evidence of these factors in the life
stories of the young ones who seek a pregnancy test and counselling.
Previous
loss/depression
Reviews of
factors leading to problem pregnancies showed, in approximately two
thirds of the women studied, a history of loss in the previous six
months prior to the problem conception. In 50%, it had occurred in the
previous three months (Greenberg, Loesch and Lakin cited in Raphael,
1972).
This is a very common feature in the history of clients at Open Doors,
especially those who have had an abortion or a miscarriage. Many suffer
from reactive depression related to their pregnancy loss and become
“stuck” in the depression phase of their grief work.
For a teenager, the death of a significant person, the
separation/divorce of parents or any other major change such as moving
house or changing schools can bring about a depression and,
consequently, lead to a greater vulnerability. It is this vulnerability
and need that may lead the adolescent into behaviour that seeks to
compensate for the emotional loss.
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“Melanie”, 16, lost her maternal grandmother after a long
illness just 4 months prior to her first contact with Open
Doors. Whilst she came for a pregnancy test, her time with
the counsellor mainly focused on her close relationship with
her grandmother and what the impact of her death entailed
for her. The opportunity to deal with her grief had been
severely restricted as Melanie’s parents’ marriage was
floundering and she felt she could not add to their problems
by disclosing her difficulties. In an attempt to deal with
her pain Melanie sought comfort in alcohol and a physical
relationship which she later recognised as further
compounding her difficulties. |
Replacing a loss
In the search for comfort or closeness the sexually active teenager’s
contraceptive vigilance is often compromised. The misguided impression
that “it couldn’t happen to me” often over-rides prudence and is
frequently a part of the adolescent’s thinking. The psychological drive
to fill the emotional void often channels the need for intimacy down the
path of an inappropriate sexual relationship.
In cases where there has been considerable loss we have seen a certain
amount of disappointment expressed by teenagers when a pregnancy test is
negative. A number of times young clients have become aware of the
intensity of their disappointment and acknowledged their longing for a
baby - as “someone to love and someone to love me”.
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For “Elise”
the disappointment that she was not pregnant was quite
apparent. After experiencing difficulties at home she
existed living in numerous squats and on the streets. Life,
in her opinion, was meaningless and a baby represented a
chance - a source of motivation to get her life in order. It
seemed she was unable to do that just for herself but a baby
would somehow fill the emptiness and offer her something in
return. |
Open Doors’ case studies show that for some women there is a tendency to
find themselves pregnant again quite soon after a pregnancy loss -
whether this be a spontaneous miscarriage or an abortion. This is an
attempt to replace the baby that has been lost.
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After a
recent termination “Tracy” returned to Open Doors for a
further pregnancy test. She was very clear that if her test
was positive she would be continuing the pregnancy. She had
realised that the decision to abort the previous time had
not been the right decision for her. Consequently she found
herself grieving - something she did not expect to do. In
talking with her counsellor she became aware of her desire
to wind back the clock and replace the baby she had lost.
Indeed she realised that she had taken active steps in a
misguided attempt to do this. |
It is also a notable occurrence that women seek a pregnancy test around
the anniversary date of the loss or around what would have been the
expected date of birth of the child. These are times of greater
vulnerability and emotional flooding. So often there may only be an
awareness of an increased restlessness and heightened sadness without a
connection being made to the direct cause of the problem.
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A caller on
our grief line sobbed as she spoke of the intensity of her
sense of loss for a baby she had aborted at the age of 18.
The news of her daughter’s first pregnancy had led to the
resurgence of her own grief which had never been expressed.
“Helen” spoke of her persistent battle with depression which
intensified at certain times of the year. After identifying
that these times coincided with the termination and when the
baby would have been delivered, Helen acknowledged a great
feeling of relief - these events now made sense. |
Deprivation and Hostility in the Family Background
Studies quoted in Abernethy, 1980 attest to a consistent pattern of
family interactions in the background of girls/women who experienced
unwanted pregnancies.
Some of theses features include:
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Hostile
distant relationships between parents
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A poor
relationship with both parents
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A
contemptuous relationship with the mother
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Male-pleasing behaviour in the mother
- unequal relationship
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An
unsatisfactory or distant relationship with the father
Again, many of
these factors are all too evident in our contact with our young clients.
They are disadvantaged and, therefore, vulnerable and may find it
difficult to control sexual activity to prevent a pregnancy from
occurring. Loneliness, boredom and the lack of sense of direction in
life are common features of the disadvantaged teenager (Condon, 1994).
Even when contraception is being used, girls reported the tendency to
become “clumsy” about its use (Fahy, cited in Twist, 1994). Motivation
to ensure against a pregnancy is often influenced by the perceived lack
of alternatives available to girls from impoverished backgrounds. The
sexual activity is often symbolic of the deeper needs and a resultant
pregnancy may be an attempt to fill the need of the mother for love i.e.
someone to love her who won’t hurt her.
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“Julie”, 14, certainly came from a background where most of
the above criteria was evident. Her parents had divorced
several months ago after many years in a relationship where
there had been regular and extensive physical and emotional
abuse. Her mother had since been involved in numerous
unsatisfactory relationships with equally dominant and
aggressive men. Julie was critical of her mother’s behaviour
and felt she didn’t care about her - she was too busy “doing
her own thing”. She rarely saw her father despite her
repeated attempts to contact him. She was basically left to
her own devices.
She engaged in sexual activity seeking closeness, a scenario
she saw modelled by her mother who was possibly seeking to
meet her own needs this way. There was little or no thought
of using contraception. Because of her age and the stresses
she was trying to cope with, Julie operated on a great deal
of “magical” thinking, denial and a restricted ability to
consider the consequences of her actions. |
Uncertain femininity
For some a pregnancy, although untimely, actually confirms the feminine
role - that is the ability to conceive and have a child. The need to
prove this comes through with varying degrees of awareness in many of
our clients’ stories.
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Our client “Helen” referred to previously in this article
expressed something of this when she spoke of her pregnancy
as a teenager. She said that she had always wanted a large
family but had a doubt about her capacity to have children
because of late development and gynaecological problems.
Confirmation of her pregnancy was in one sense a great
relief for her but, on the other hand, she was now faced
with the agonising decision of whether to continue the
pregnancy. Believing she had no other option she chose to
terminate. Until the actual birth of her next child, she
battled with the fear that the child she had aborted would
be her only chance at motherhood. |
Hostility in parental relationships coupled with an inequality in
that relationship may affect how the young girl sees her own gender
role. She may doubt her ability to maintain her sense of self in ways
other than through acquiescence in a sexual relationship.
Where there has been an unsatisfactory father/daughter relationship, the
girl may seek to compensate for the lack of love (perceived or real) in
sexual encounters. In reality she may be seeking her father’s love and
approval.
Self punishment
An unplanned pregnancy may place enormous restrictions on the
individual, especially the teenager. Plans and goals are thwarted
causing disarray and turmoil. Irrespective of the choice in dealing with
an unplanned pregnancy, the person is led to the point of making a
decision that will impinge dramatically on her life. If she decides to
go on with the pregnancy, she faces the responsibilities and
difficulties associated with pregnancy, childbirth and child rearing.
Alternatively, if abortion is the choice, the heartache that may follow
such a decision may be interpreted by the individual as her due
punishment. Abortion may indeed be translated as the ultimate
self-punishing act.
Where self esteem is low a greater vulnerability exists. Reserves are
down and so the ability to withstand pressure to participate in “at
risk” behaviour is compromised. Particularly where there has been a
history of deprivation or abuse, a tendency to perpetuate the status quo
may be reflected in self-destructive activities.
In many instances substance abuse may be involved. Drugs and alcohol,
often used to escape reality, are destructive elements often fuelled by
an unconscious desire to punish oneself for either real or perceived
transgressions.
Too often we hear phrases such as “Everyone’s doing it”, “So what,
there’s nothing else to do”, “What does it matter?” echoing a sense of
helplessness and hopelessness in our young people.
Conclusion
So often it is difficult to make sense of what it is that motivates
human behaviour. It may be quite obvious what it is that we should do or
need to do, however we may ultimately do the opposite. The answer to
this paradox often lies in the unconscious. Unwanted pregnancies, the
beginning of sexual relationships in an unsafe setting and the other
innumerable difficulties that are experienced by vulnerable teenagers
often do not occur randomly, but usually in the context of a background
that leaves them prone to some misfortune.
The implication is that beyond the sole application of “safe sex”
education and contraceptive principles, a therapeutic psychological
awareness and intervention is needed.
References
Abernethy, V., (1980) Unwanted pregnancy: A psychological profile on
women at risk. In J.T. Burchaell (Ed.), Abortion Parley. Andrews &
McMeel. New York.
Condon, J., (1984) Unrealistic ideas cited over teen pregnancies. Dr
Weekly.
Fact Sheet 8, Teenage Pregnancy 1995 The Centre for Adolescent Health
Royal Children’s Hospital, Melbourne, Victoria 1995.
Raphael, B., (1972) Psychological aspects of induced abortion. Mental
Health in Australia. 5., (1).
Twist, Shirley, (1994) Teen Mums look for love, drift into pregnancy.
The Australian, 9 Feb 1994
OPEN DOORS
COUNSELLING
5 Greenwood Ave Ringwood. 3134
Ph: (03) 9870 7044
Freecall outside Melbourne 1800 647 995
Email: info@opendoors.com.au
Updated May 2005 |
