by Anne Neville
R.N., R.M., Dip. Past. Psych., Dip. Marriage & Family Therapy,Cert. Interpersonal Relationship Therapy, Accredited Grief & Loss Counsellor National Association of Loss & Grief (Vic) Clinical Member CAPAV. PACFA Reg: 21127
“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.
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.
Of note is a 2010 Teen Parents Research Report that demonstrated that one of the biggest challenges amongst new mothers is the change in their identity. Teenage mothers feel this is definitely more so for them because they had not yet fully developed a sense of their own identity when the baby was born (Harmen, 2010).
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.
Adolescents at greater risk
The lack of consistent data collection standards across the states makes it difficult to accurately quantify the number of abortions performed in Australia each year, however it is generally accepted that it could be as many as 90,000. It is therefore difficult to accurately report on teenage pregnancy rates as there is no requirement for mandatory reporting of abortions nationally or in any state with the exception of South Australia. In 2006, 892 South Australian teenagers gave birth, and a further 998 had abortions (Chan, Scott, Nguyen and Sage, 2007). These figures indicate that teen pregnancy rates could be at least twice birth rates. This is supported by estimates derived from Australian Bureau of Statistics and Australian Institute of Health and Welfare data, which suggest that Australia’s rate of teenage pregnancy is around 38.9/1000 women aged 15-19 years (Shine, 2008).
Australian teen pregnancy numbers have been relatively high: this country ranked 11th among 28 OECD countries on UNICEF’s teenage birth ‘league table’ in 2001. With a birth rate of 18.1 per 1000 women aged 15 to 19, Australia was similar to Ireland, Poland and Canada, but considerably lower than the United States (which has the highest teen birth rate in the developed world, at 52.1/1000), the United Kingdom and New Zealand (UNICEF, 2001).
In Australia, the number of teenage women giving birth has fallen over the last 20 years with the 2011 rate being 15.6 births per 1,000 women, compared to 55.5 births per 1,000 women in 1971. However, this in no way represents the true extent of the teenage pregnancy rate, given the current availability of abortion (Better Health Channel, cited online April 24/4/2014). The abortion rate for teens in 2010 was 52% (South Australian Abortion Reporting Committee, 2010).
Social issues related to teenage pregnancy
These days, teenagers who do give birth are more likely to keep the child rather than choose adoption as an alternative. When the option of adoption is raised, so many say (mature women too) that they couldn’t go through the pregnancy and “give the baby away”. They are not to know that choosing abortion may actually affect them more profoundly.
Fortunately the social stigma of being a young parent is less common today than in the past. The availability of government payments and support services for young mothers has helped make parenting a more acceptable option for many young women (BHC, cited 24/6/2014).
However, although some young women find raising a child to be a positive and rewarding experience, the social issues that can be associated with teenage pregnancy include:
- Not being able to complete her education
- Facing long-term unemployment or job options that are poorly paid and insecure
- Dependency on welfare
- Financial pressure – not being able to afford basic necessities
- Poor housing arrangements
- A lack of acceptance, support and understanding from the young woman’s family members and friends
- Greater risk of maternal mental health issues such as postnatal depression
- The use of alcohol and drugs
- Feeling that they have no opportunities to recognize their own potential
- Being in an environment where teen pregnancy is common
- Lack of role models in their family or in their other contacts
- Suffering from depression or other mental health issues
Being involved in dating or sexual activity at a young age is a major risk factor for unprotected sex and the potential pregnancies and STIs that go with that choice. The younger a teen is when he or she first has sex, the more likely he or she is to have unprotected sex resulting in a pregnancy or an STI.
Some reasons teens may have sex at a young age are:
- Pressure from an older boy or girlfriend to have sex
- The media often conveys the idea that teen sex is common and acceptable
- Teens often do not get good information about sex, relationships, and values from reliable sources, such as parents. They may feel embarrassed and don’t want to ask parents questions
- For girls, a belief that having sex will give them emotional intimacy
- For boys, a belief that having sex will give them higher social status with their peers
Teens who feel pressured to have sex because “everyone is doing it” should know that more than half of teens wait until they are older to have sex (Stayteen.org, online 1/7/2014).
Why some teens want to get pregnant
Many teen girls come from lower income groups and don’t expect much from their future. Many have boyfriends 5 or more years older than themselves and are more vulnerable to coercion to have sex. Their reasons for wanting a baby may vary, but often include:
- They think somehow it will stop their boyfriend from leaving them – however most teen mothers do end up being single
- They can romanticize about having a baby
- They believe being a mother will give them a sense of fulfilment
- They don’t see any better options for their future than getting pregnant and dropping out of school
- They think having a baby seems like a good alternative to finishing school
Why teens have unprotected sex
Many unplanned teen pregnancies are the result of unprotected sex. Ninety percent of teens having unprotected sex will get pregnant within a year (Habib, 2006).
There are a number of reasons that teens may have unprotected sex:
- They feel like pregnancy and STIs are things that only happen to other people, though each year nearly 1 million teen girls get pregnant and nearly 10 million teen boys and girls get STIs from unprotected sex
- One or both teens used drugs or alcohol before sex
- They don’t know the risks of unprotected sex
- They are not emotionally mature enough to make safer choices about sex
- They may feel on the outer and believe that “everyone’s doing it”
- They feel pressured by their partner to have unprotected sex (Habib, 2006)
- They feel embarrassed about asking for or buying contraception
Risk factors for teen sexually activity and teen pregnancy include:
- Using alcohol, drugs, or tobacco
- Dropping out of school, or not having a commitment to education
- Having little social support, such as caring family or friends
- Not feeling involved with family, school, or community
- Feeling like they have no opportunities, or not recognizing their own potential
- Being in an environment where teen pregnancy is common
- Living in poverty
- Being a victim of sexual abuse
- Being the child of a teen mother
- Suffering from depression or other mental health problems (Teen Pregnancy Statistics, 2009)
Higher Risk Factors for Teens
Whilst having a baby as a teenager has its difficulties, “the risks of terminating seem to be even more pronounced” (Coleman, 2006).
Previous studies on teens and abortion have also found:
- Teens are 6 times more likely to attempt suicide if they have had an abortion in the last six months than are teens who have not had an abortion
- Teens who abort are up to 4 times more likely to commit suicide than adults who abort, and a history of abortion is likely to be associated with adolescent suicidal thinking
- Teens who abort are more likely to develop psychological problems and are nearly three times more likely to be admitted to mental health hospitals than teens in general
- Teens who abort are twice as likely as their peers to abuse alcohol, marijuana, or cocaine
- Teens are more likely to abort because of pressure from their parents or partner, more likely to report being misinformed in pre-abortion counselling and more likely to have greater difficulty coping after abortion (Coleman, 2006).
We know there is so much information out there about sex education and the use of contraception. This would seem to the logical solution to the problem of unwanted pregnancies, however, widespread knowledge, availability and use of contraception has not 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 can be at a far greater risk of unplanned pregnancies because of factors related to their psychological immaturity. They are in the process of their search for a sense of identity, forming relationships, adjusting to the reality of their newly acquired fertility and establishing a balance between their aspirations, fantasies, and reality. This, combined with their as yet incomplete brain development, can result in their decision-making capacity being sorely compromised.
Teenage clients presenting at Open Doors are usually in a state of crisis. The possibility of an unplanned pregnancy constitutes a very significant crisis – one that threatens to turn their world upside down. The immediate problem (a pregnancy) may seem to be the only problem.
However, it has been found that some women seem to have a tendency to conceive more frequently than others in situations when they believe it is not their conscious intention to have a baby. A teenager usually doesn’t deliberately decide to become pregnant, although we know there are some instances when this is the case as mentioned above.
Most of us would be familiar with the term “accident prone” and so, in our clients, we can identify certain features in their life history that may predispose them to an unplanned pregnancy (often totally unconscious). We refer to this as pregnancy proneness.
Pregnancy Proneness – predisposing features
There is a whole cluster of issues that may predispose a teenager to an unplanned pregnancy:
- family situations with regular conflict between members
- family violence or sexual abuse during childhood
- unstable housing arrangements
- living in out of home care
- poor school performance and attendance
- low socio-economic background
- family history of pregnancies at a young age
- low level of maternal education
- low self-esteem
- undisclosed same-sex attraction
- Aboriginal or Torres Strait Islander status
- living in rural and remote areas
- having a mental health diagnosis
(Better Health Channel, Copyright @ 1999/2014).
On a psychological level, Raphael (1972) described a number of underlying issues that may lead to a pregnancy when clearly there was no conscious decision to have a baby. Many of the predisposing factors mentioned above are also a part of the history of those facing an unplanned pregnancy.
Raphael identified the following issues in the history of those having to decide about an unplanned pregnancy. These are depression, replacing a loss, deprivation and hostility in childhood, uncertain femininity, and self-punishment as significant. Together both these sets of features speak of vulnerability and loss.
Amongst Open Doors’ clients we often see evidence of these factors in the life stories of the young ones who seek pregnancy counselling.
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 (Teen Pregnancy Statistics, 2009). It is this vulnerability and need that may lead the adolescent into behaviour that seeks to compensate for the emotional loss – emotions can be intense and the desire to be connected with someone can lead to a need for intimacy.
Some grieving teens may even behave in ways that seem inappropriate or frightening. Be on the watch for:
- Periods of feeling low and withdrawn
- Sleeping difficulties
- Bouts of anger
- Lack of motivation
- Low self esteem
- Academic failure or indifference to school-related activities
- Deterioration of relationships with family and friends
- Risk-taking behaviours such as drug and alcohol abuse, fighting, and sexual experimentation
- Denying pain while at the same time acting overly strong or mature Helping Teenagers Cope with Grief (cited online 10th June, 2014).
‘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 that she later recognised as further compounding her difficulties.
‘Susie’s’ mother decided that she could no longer ‘cope’ with raising her at the age of 5 and left her in the care of her grandparents whilst she took off to Queensland. Susie spoke about how abandoned she felt and remembered how, for several years, she’d run to the front door at the sound of any car in the driveway – hoping that ‘Mummy had come back’ for her. Susie said she loved her grandparents dearly and when her mother did come back to collect her at the age of 12 she refused to go, not wanting to be taken away from her grandparents with whom she had come to experience as her parents.
Replacing a loss
In the search for comfort or closeness the sexually active teenager’s contraceptive vigilance is often compromised. The misguided view that ‘it couldn’t happen to me’ often over-rides any clarity of thought and caution can be thrown to the wind. 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 have acknowledged their longing for a baby – as ‘someone to love and someone to love me’.
For ‘Elise’ the disappointment that she was not pregnant was quite apparent. After experiencing difficulties at home, she lived 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.
After an abortion it is not unusual to hear a girl say ‘I want a baby so bad’. Open Doors’ case studies show that for some women there is a tendency to find themselves pregnant again quite soon after an abortion. Their situation may be exactly the same – this is a re-enacting of the first pregnancy and abortion (Burke & Reardon, 2002).
Australia has a repeat pregnancy rate of 37% and for those under 30 it is nearly 50%, clearly indicating that the lack of contraception education is not the issue (Dept Human Services, 2007). Unconscious factors influencing behaviour that lead to a further pregnancy are often only identified through counselling.
A replacement pregnancy can be seen as an ‘undoing’ mechanism – an attempt to turn back the clock after an abortion. Approximately half of all women who have had an abortion have had one or more previous abortions (Burke & Reardon, 2002). This is an attempt to replace the baby that has been lost – something that just can’t happen. There is often a huge outpouring of grief when this reality hits home.
Returning to Susie’s situation – she longed for a ‘real’ family and when she met ‘Daniel’ at age 19 thought here was the chance for her to marry and start a family. When Susie became pregnant Daniel was initially excited but a few days later he became anxious that the time wasn’t right and said that Susie should have an abortion. He promised her that they could have a baby when they were more established – in a couple of years’ time. As often happens when a woman goes against what she believes in and has an abortion because of pressure, the relationship disintegrates leaving her with another significant loss to deal with.
So Susie had an abortion and found herself crippled by post-abortion grief. All she wanted was to turn back the clock and start again. She wanted another baby so much that she ‘made up’ with her ex-boyfriend and they spent the next weekend together. Once she had a further pregnancy confirmed she broke off the relationship – for her Daniel had played his part and she no longer needed him. Sadly, Susie later had a miscarriage.
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 not at all unusual for post-abortive women to seek a pregnancy test around the anniversary date of the abortion 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.
‘Helen’ 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.
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:
- Hostile distant relationships between parents
- A poor relationship with both parents
- A contemptuous relationship with the mother
- Unstable housing arrangements
- Family violence or sexual abuse during childhood
- Male-pleasing behaviour in the mother – an unequal relationship
- 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. Teens who begin dating at age 12 have a 91 percent chance of being sexually active as teens (Teen Pregnancy Statistics, 2009).
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.
‘Julie’, 14, certainly came from a background where most of the above criteria were 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.
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.
Our client ‘Helen’ (see above) 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.
An unplanned pregnancy may place enormous restrictions on the individual, especially a teenager. Plans and goals are suddenly compromised, causing confusion and turmoil. Irrespective of the choice in dealing with an unplanned pregnancy, the girl/woman is led to the point of having to make 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. This happens at a time when her main focus should be in finding her place in the world and forming her own sense of identity.
Alternatively, if a teen ‘chooses’ abortion, the heartache that may follow may be interpreted as her due punishment. Abortion may indeed be interpreted as the ultimate self-punishing act. This response is often tied up with her struggle with guilt. This isn’t something only the religiously minded experience but rather comes from a deeper sense of spirituality within. Some women talk about how they’ve done something that goes against their normally held view on abortion. Finding themselves faced with an unplanned pregnancy, the fear and panic can take over, leading them down the path to abortion.
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.
It is often 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 are experienced by vulnerable teenagers. These often do not occur randomly but are usually experienced within the context of loss and grief issues. It is in identifying these factors and understanding their significance that a teen can be empowered to make healthier choices.
The implication is that beyond the sole application of ‘safe sex’ education and contraceptive principles, a therapeutic psychological awareness and intervention is needed.
Teens are the next generation of leaders for our society. Parents play a major role in educating their teens about their values and the possible consequences of teen sex and unprotected sex. Building trust and encouraging their children to come to them when there is an issue helps teens to feel involved and cared for in the discussion.
Burke, T and Reardon, D, Forbidden Grief: The Unspoken Pain of Abortion Acorn Books, 2002.