Impact of demographic factors, early family

relationships and depressive

symptomatology in teenage pregnancy

Julie A. Quinlivan, Louisa H. Tan, Angela Steele, Kirsten Black

Aim: Teenage pregnancy has been well studied from a demographic risk perspective, but
less data examining the early interpersonal family experiences of teenage mothers are
available. We aimed to explore the relative impact of demographic, early interpersonal family
relationships and depressive symptomatology as associations for teenage, as compared to
non-teenage, childbearing.
Method: A prospective cross-sectional cohort study was undertaken. Institutional ethics
committee approval and informed consent were obtained. Data from consecutive teenage
(teenage) and non-teenage (control) subgroups of antenatal women were compared.
Subjects were interviewed and completed the following questionnaires: demographic, drug
use and lifestyle; early life experiences; Hospital Anxiety and Depression Scale (HADS); and
General Health Questionnaire-28.
Results: In multivariate analysis, the following factors had a significant independent
association with younger age of motherhood in order of magnitude: a history of parental
separation/divorce in early childhood; exposure to family violence in early childhood; illicit
drug use (ever or in pregnancy); idealization of the pregnancy; low family income; a positive
HADS-A or HADS-D subscale score; and a low level of education.
Conclusion: Interventions to reduce the rate of teenage births need to be multifocal and
should include strategies to address early childhood exposure to parental separation
and violence, reduce idealization of pregnancy, diagnose psychological symptomatology and
offer alternative career choices to children defaulting in the education system.
Key words: depression, divorce, domestic violence, early life stress, family, GHQ-28,
HADS, idealization, teenage pregnancy.

Australian and New Zealand Journal of Psychiatry 2004; 38:197–203

Pregnancy during the teenage years is an overwhelm-
ing experience with the teenager simultaneously coping
with the developmental challenges of adolescence and
Julie A. Quinlivan, Associate Professor (Correspondence); Louisa H. Tan,
Advanced Medical Science student
Department of Obstetrics and Gynaecology, The University of
Melbourne, Royal Women’s Hospital, 132 Grattan St Carlton 3053
Victoria, Australia. Email: julieq@unimelb.edu.au
Angela Steele, Midwifery Co-ordinator Young Mothers Clinic; Kirsten
Black, Fellow in Clinical Effectiveness
Royal Women’s Hospital, Melbourne, Australia
Received 9 May 2003; revised 2 October 2003; accepted 17 November
2003.
parenthood [1]. Children of teenage parents are likely to
be disadvantaged financially and have poor health [2].
Furthermore, because young parents are less likely to
complete basic schooling, they may not have the neces-
sary knowledge to educate their children about general
issues [2]. Their children are therefore at increased risk
of developmental delay, poor performance in school and
learning problems [3,4]. The ongoing cycle of poverty,
unemployment, poor academic achievement and physi-
cal abuse suggests that intergenerational family pathol-
ogy may be a leading factor in the aetiology of teenage
pregnancy.
198 EARLY LIFE FACTORS MAY PREDICT TEENAGE CHILDBEARING
While many studies on teenage pregnancy have
explored the demographic and risk behaviours of teenage
mothers, less data have evaluated the early interpersonal
family relationships experienced by teenage mothers
when they themselves were children [4–6]. The lack of
data has led to the focus on demographic variables in
addressing strategies to reduce the risk of teenage preg-
nancy. However, not all teenagers in ‘at-risk’ demo-
graphic categories become teenage parents, so it is clear
that the story is more complex. Other factors suggested
as key associations include exposure to family violence,
early parental divorce or separation, adverse relation-
ships with parents, factors relating to poor self esteem
and lack of alternative life pathways and undiagnosed
depressive symptomatology. The relative impact of these
factors compared with demographic variables has not
been explored.
We planned to explore the relative impact of demo-
graphic, early interpersonal family relationships and
depressive symptomatology as associations for early age
of onset of motherhood.
Method
A prospective cross-sectional cohort study was undertaken at the
Royal Women’s Hospital, Victoria, Australia, a tertiary referral centre
for obstetrics. Institutional ethics committee approval and individual
informed consent were obtained. Data from teenage (teenage) and non-
teenage (control) subgroups of mothers were compared.
Subjects in the teenage subgroup of the study (teenage) were con-
secutively enrolled from ‘young mothers’ and general antenatal clinics.
Female subjects eligible for enrolment into the teenage subgroup were
aged less than 20 years. Subjects in the control group (control)
were consecutively enrolled from general antenatal clinics. Female
subjects eligible for enrolment into the older control cohort were all aged
over 20 years. Teenage and control women were eligible for participa-
tion in the study if they did not intend to relinquish their infant, were
nulliparous and had no known fetal anomaly in the pregnancy.
Assessment tools
Subjects were interviewed by a research staff member and completed
several questionnaires. The first questionnaire asked about demo-
graphic variables such as the subject’s age, gravidity, smoking, alcohol
and illicit drug use patterns before and during the pregnancy, ethnic
background, level of education and family income. Subjects also
provided feedback regarding their personal assessment of their support
levels by selecting an answer from a series of options relating to their
social supports, housing security, emotional impression of the
pregnancy and future career plans.
The second questionnaire asked questions about the subject’s early
interpersonal family relationships with and between their parents. The
first part of the family relationship questionnaire asked about their
relationship with their mother. An example question was: ‘Please take
a moment to think about your relationship with your mother (or
stepmother, mother figure) while you were growing up (that is, while
you were a child). Please tick all the responses that apply.’ The
possible responses to the question included: loving and affectionate;
critical and rejecting; strict and demanding; respectful and accepting;
attentive and caring; unresponsive and disinterested; understanding
and sympathetic; intrusive and overprotective; or, there was no woman
like this in my life. According to the items selected, responses were
coded as negative, positive, mixed or absent. A negative response was
coded if subjects only indicated options from the following items:
critical and rejecting; strict and demanding; unresponsive and dis-
interested; or intrusive and overprotective. Alternatively, a positive
response was coded only if subjects indicated options from the follow-
ing items: loving and affectionate; respectful and accepting; attentive
and caring; or understanding and sympathetic. A combination of the
above positive and negative responses was coded as a mixed response.
Finally, subjects who indicated that ‘there was no woman like this in
my life’ were coded as absent.
The second and third parts of the family relationship questionnaire
asked about their relationship with their father, and between their
parents. Data were collected and coded in a similar manner. The
selection of the ‘violent’ option to describe the relationship between
parents was considered separately as family violence. These responses
were explored by discussing the types of violence, age exposed and
perpetrators in formal social work appraisals. Finally, subjects were
asked to indicate whether they had experienced parental separation or
divorce during their childhood.
Finally, women completed the Hospital Anxiety and Depression
Scale (HADS) [7] and the General Health Questionnaire-28
(GHQ-28) [8].
In 20% of subjects, answers in questionnaires were validated by
cross-referencing against data provided in an interview by a qualified
social worker. From the total of 575 variables from the 20 subjects
directly compared, there was agreement in 564 (agreement 98%, κ-test
ratio 0.96). Thus, interobserver agreement was extremely high.
Primary outcome and power calculation
The primary hypothesis was that women, in the setting of teenage
pregnancy, would be significantly more likely to describe their relation-
ships with and between their own parents in a negative or absent
fashion, compared to women over 20 years of age (controls). It was a
priori estimated that 50 women in each arm of the study would have
greater than 80% power to detect as significant at a two-sided α-error
of 0.05, a difference in the incidence of negative or absent parental
descriptions in the teenage and control subgroups of 35% and 10%,
respectively. Therefore, the study required 100 women.
Secondary outcomes
There were several secondary outcomes. They were that women, in
the setting of teenage pregnancy compared to older pregnant women,
would be more likely to describe the relationships between their parents
as: violent; more likely to have experienced parental separation or
divorce; have significant differences in lifestyle factors such as drug
use, and social factors such as education, income, housing and support;
and have higher levels of psychiatric contact and psychological
symptomatology, the latter as measured using HADS and GHQ-28.
 J.A. QUINLIVAN, L.H. TAN, A. STEELE, K. BLACK
Statistical analysis
Data were analyzed using SAS (Cary, North Carolina, 2002). In
group comparisons of discrete data, the χ2 or Fischer’s exact tests were
applied. The χ2 statistic, degrees of freedom and p-value are presented
for tables with more than 1 degree of freedom. Otherwise, the p-value,
odds ratio and 95% confidence interval are presented. The Student’s
t-test or Mann–Whitney U-test were applied to generate p-values of
continuous data with normal and skew distributions, respectively. To
evaluate for independent associations with younger maternal age of
childbirth, stepwise regression analyses were applied incorporating all
variables significant at p = 0.1 on univariate analysis.
Results
Of 56 consecutive, eligible, pregnant teenage women approached to
participate in the study (teenage group), informed consent was obtained
from 50 (89% response). The principle reason for declining par-
ticipation was a fear of a breach of confidentiality. Of 60 consecutive,
eligible, pregnant women over 20 years approached to participate in the
study (control group), informed consent was obtained from 50 (83%
response). The principle reasons for declining participation were
disinterest in the study and concern over confidentiality.
The demographics of the teenage and control cohorts were similar to
data available for Victoria and Australia. The mean age of the teenage
group was 17.5 years, compared with the mean age of 18 years for
teenagers giving birth in Victoria. The mean age of the control group
was 27.1 years, compared with the mean age of 27.7 years for women
having their first baby in Victoria [9]. The proportion of the teenage
group with a religious belief was 46%, and in teenage mothers
Australia-wide it was 43%. The proportion of the controls with a
religious belief was 82%, and Australia-wide it was 75% [10].
The background demographics of the two groups were significantly
different. There were racial differences in the two maternal groups,
with significantly more women of Caucasian and fewer of Asian
background in the teenage group, compared to controls (p = 0.0015).
The teenage group included four (8%) indigenous Australians com-
pared to none in the control group. The educational background of the
teenage group was significantly lower than controls (p < 0.0001) and
remained so after adjusting for the influence of age (p < 0.0001).
Family income was significantly lower in the teenage group compared
to controls, with 50% of the teenage group receiving less than $15 000
per year, compared to only 8% of controls (p < 0.0001). Significantly
fewer of the teenage group were married (8%) compared with 75% of
controls. Significantly more teenage mothers had no fixed address
or were living in a very unstable household compared to controls
(homeless/very unstable home: teenage 32%, control 0%, p < 0.0001).
Overall, there were significant differences in career objectives between
teenage mothers and controls (p = 0.022). In subanalysis, teenage
mothers were significantly less likely to have plans for any job or
career in the future compared to controls (job – any/semiskilled/
professional: teenage 28%, control 54%, p = 0.0085). Conversely, sig-
nificantly more teenage mothers identified ‘parent’ as their sole career
choice compared to controls (teenage 42%, control 24%; p = 0.01).
Teenage mothers were significantly less likely to state that they had a
religious belief compared to controls (teenage 42%, control 82%;
p = 0.0002). However, there were no significant differences between
199
the two groups in terms of gravidity, previous miscarriage or abortion
(all p > 0.05).
Table 1 summarizes drug use. At the start of pregnancy, signifi-
cantly more of the teenage group smoked compared to controls. With
the onset of pregnancy, 60% and 77% of cigarette-smoking teenage
and control mothers ceased smoking. However, significantly more
teenage mothers continued to smoke into their pregnancy than con-
trols. Significantly more teenage mothers used alcohol at the start of
the pregnancy compared to controls. With the onset of pregnancy, 73%
and 86% of alcohol drinking teenage and control mothers quit. There
were no significant differences in the numbers continuing to drink
alcohol throughout pregnancy between the two groups (p = 0.09). The
majority of mothers cited pregnancy as the main reason for ceasing
smoking and alcohol, respectively. Significantly more teenage mothers
were illicit drug users at the start of the pregnancy than controls. With
the onset of pregnancy, 75% and 100% of illicit drug-using teenage
and control mothers stopped using drugs. However, significantly more
teenage mothers continued to abuse drugs into their pregnancy com-
pared to controls. The spectrum of drugs used was similar between the
two groups and was dominated by marijuana and amphetamines.
There were marked differences in social supports between the two
groups. Pregnancy was significantly more likely to have occurred in an
unplanned setting in teenage mothers compared to controls (unplanned:
teenage 64%, control 30%, p = 0.0003). Significantly more teenage
mothers idealized the pregnancy and regarded it as the ‘single most
exciting and positive event to have occurred in my life’ compared to
controls (teenage 52%, control 32%, p = 0.05). Social support was
significantly lower among teenage mothers than controls. Fifteen
percent of teenage mothers could only rely on themselves for support
with the baby, and a further 15% had only themselves and their partner.
In contrast, all control mothers could identify at least one other person
apart from themselves and the father of the baby, as being able to
provide support about the birth (p < 0.0001). The majority of control
mothers could rely on three or more other people to help them with
their newborn (three or more other people available for support:
teenage 40%, control 84%, p < 0.0001). A previous psychiatric history
was significantly more common in the teenage group than controls
(teenage 18%, control 0%, p = 0.002).
Table 2 summarizes the childhood familial relationships of the
female cohort. Significantly more teenage mothers reported a negative
or absent relationship with their mother and/or father compared to
older controls. Of note, in the teenage group, significantly more mater-
nal, as compared to paternal, relationships were described in a positive
manner (p < 0.0001). However, there was no significant difference in
the proportion of positive maternal and paternal relationships in con-
trols (p = 0.21). Teenage mothers reported more negative and absent
relationships between their parents than controls. Correspondingly,
they also reported significantly fewer positive parental relationships
than controls. Childhood exposure to a violent parental relationship
was significantly more common in the teenage group, as compared to
controls. Childhood experience of parental separation and/or divorce
under 5 years of age was also significantly more common in the
teenage group, as compared to controls.
Table 3 summarizes the HADS and GHQ-28 data of the study
cohort. The total HADS score and both subscale scores were signifi-
cantly higher in teenage, as compared to control women. The GHQ-28
total and anxiety subscale scores were also significantly higher in
teenage, as compared to control women.
200 EARLY LIFE FACTORS MAY PREDICT TEENAGE CHILDBEARING

Table 1. Drug use of the study cohort

Variable Teenage Control p-value

(Maternal age < 20 years) (Maternal age > 20 years) OR (95% CI)
Smoking
Current smoker
Yes 17 (34%) 3 (6%) p = 0.0005
No 33 (66%) 47 (94%) 8.07 (1.99–37.9)
Ex-smoker
Yes 26 (52%) 10 (20%) p < 0.0001
No 7 (14%) 37 (74%) 13.74 (4.13–48.2)
Reason stopped
Pregnancy 22 (85%) 5 (50%) p = 0.08
Other 4 (15%) 5 (50%) 5.50 (0.84–39.9)
Alcohol
Current user
Yes 8 (16%) 2 (4%) p = 0.09
No 42 (84%) 48 (96%) 4.57 (0.83–33.1)
Ex-alcohol user
Yes 22 (44%) 12 (24%) p = 0.008
No 20 (40%) 36 (72%) 3.30 (1.24–8.91)
Reason stopped
Pregnancy 20 (91%) 11 (92%) p = 1.00
Other 2 (9%) 1 (8%) 0.91 (0.0–15.5)
Illicit drugs
Current user
Yes 6 (12%) 0 (0%) p = 0.012
No 43 (86%) 50 (100%)
Don’t wish to state 1 (2%) 0 (0%)
Ex-drug user
Yes 18 (36%) 4 (8%) p = 0.001
No 24 (48%) 45 (90%) 8.44 (2.31–33.6)
Don’t wish to state 2 (4%) 1 (2%)
Reason stopped
Pregnancy 10 (56%) 2 (50%) p = 1.00
Other 8 (44%) 2 (50%) 1.25 (0.09–16.9)
Types of drugs used
Marijuana 22 (92%) 3 (75%)
Amphetamine 5 (21%) 1 (25%)
Ecstasy 3 (13%) 1 (25%)
Other 0 (0%) 0 (0%)

In order to determine the variables that might have an independent Discussion

association with teenage pregnancy, stepwise multivariate analysis was
performed on all factors significant on univariate analysis, with the
p-value for inclusion set at 0.1 or less. The model included race, level
of education, family income, housing status, career plans, religion,
smoking, alcohol, illicit drug use, pregnancy planning, idealization of
pregnancy, social supports, psychiatric history, childhood relationship
with the mother, father and between the parents, childhood exposure to
parental violence and parental separation/divorce under the age of
5 years, HADS-A and HADS-D subscale scores. The dependent vari-
able was age at the time of delivery of the newborn. Childhood
exposure to parental separation/divorce and domestic violence had the
greatest strength of association with early age of onset of pregnancy.
Other factors significant on multivariate analysis were illicit drug use,
idealization of pregnancy, low family income, HADS-A and HADS-D
subscale scores greater than 8 and low level of education. These data
are summarized in Table 4.
Although demographic issues surrounding teenage
mothers have been well researched, relatively little is
known about the quality of the early life-relationships
experienced by teenage mothers. This is the first Aus-
tralian study to model the multiple risk factors identified
in univariate analyses of teenage pregnancy derived
from epidemiological and cohort studies against in-depth
interview data that covered demographic, social, family
and emotional domains. We observed that the strongest
associations with a younger age of motherhood arose
from adverse early life experiences in the teenager’s
home. The factors with strongest independent associa-
tion with teenage motherhood were childhood exposure
to parental separation or divorce and childhood exposure
 J.A. QUINLIVAN, L.H. TAN, A. STEELE, K. BLACK 201

Table 2. Childhood familial relationships of study cohort

Variable Teenage Control p-value

(Maternal age (Maternal age OR (95% CI)
< 20 years) > 20 years)
Childhood relationship with mother
Positive 20 (40%) 39 (78%) p = 0.00016
Mixed 7 (14%) 7 (14%) χ2 20.17
Negative 13 (26%) 1 (2%) 3 df
Absent 10 (20%) 3 (6%)
Childhood relationship with father
Positive 9 (18%) 32 (64%) p < 0.0001
Mixed 12 (24%) 11 (22%) χ2 26.39
Negative 12 (24%) 3 (6%) 3 df
Absent 17 (34%) 4 (8%)
Childhood relationship between subject’s parents
Positive 15 (30%) 39 (78%) p = 0.0001
Mixed 4 (8%) 1 (2%) χ2 24.71
Negative 17 (34%) 8 (16%) 3 df
Absent 14 (28%) 2 (4%)
Childhood exposure to violent parental relationship
Yes 11 (22%) 1 (2%) p = 0.0004
No 27 (54%) 47 (94%) 19.15 (2.32–40)
Don’t know 12 (24%) 2 (4%)
Childhood experience of parental separation/divorce
under 5 years of age
Yes 28 (56%) 4 (8%) p < 0.0001
No 17 (34%) 46 (92%) 18.94 (5.23–75.4)
Don’t know 5 (10%) 0 (0%)

Table 3. HADS and GHQ-28 scores of study cohort

Variable Teenage Control p-value

(Maternal age < 20 years) (Maternal age > 20 years)
HADS median (IQR)
HADS-Total 13 (9–16.75) 8 (4–13) < 0.0001
HADS-A 8.5 (5–10.75) 5 (2–8) < 0.0001
HADS-D 5 (3–7) 3 (1–6) 0.005
GHQ-28 median (IQR)
GHQ-28 total 11 (8–21.5) 6 (2–15.5) 0.013
GHQ-28 somatization 4 (2–8) 2 (0–6) 0.15
GHQ-28 anxiety 5 (2–8) 2 (0–5.5) 0.001
GHQ-28 personality 4 (2–6) 2 (0–4) 0.18
GHQ-28 major depression 0 (0–1.5) 0 (0–0) 0.07

to family violence. Other independent associations were
seen in respect to illicit drug use, idealization of preg-
nancy, low family income, the presence of psychological
symptomatology in the domains of both anxiety and
depression, and a low level of education.
Teenage motherhood was positively correlated with a
childhood experience of parental separation/divorce.
The finding is supported by retrospective and epidemio-
logical data from other countries. In a UK study, women
who were raised in single parent families due to parental
separation were at increased risk of becoming teenage
parents [3]. A retrospective epidemiological study from
the USA analyzed birth data for the years 1995–1996
and reported a strong positive relationship between
single-parent households and teenage pregnancy [11].
While the prevalence of a personal history of physical,
sexual and/or emotional abuse in teenage mothers has been
reported to be higher compared with older childbearing
202 EARLY LIFE FACTORS MAY PREDICT TEENAGE CHILDBEARING
Table 4. Significance of patient factors on multivariate analysis
Variable
Childhood exposure to parental separation/divorce under 5 years of age
Childhood exposure to domestic violence
Illicit drug use
Idealization of pregnancy
Low family income
HADS-A (anxiety subscale score)
Low level of education
HADS-D (depression subscale score)
Confidence intervals containing zero mean no association may exist.
women [12], the relative strength of association of early
childhood exposure to family violence and age of onset
of motherhood has not been well explored. We found
that a childhood experience of violent parental relation-
ship was an independent association of younger age of
motherhood. The finding is consistent with a small
Israeli study, where teenage mothers were found to have
a higher chance of experiencing childhood family vio-
lence than their non-pregnant peers [13]. Witnessing a
violent relationship between one’s parents creates an
extremely hostile childhood environment, where the
child may be scared of the abusing parent/s, communica-
tion may be poor and the parent–child relationship com-
promised. Parental separation may also occur, resulting
in an unstable family structure. Having witnessed the
continual battering of a parent, the child may leave home.
This may then bring about a range of consequences, such
as homelessness, educational and financial disadvantage,
lack of social support and a higher chance of committing
health-risking behaviour due to an absence of parental
guidance. There may be an ongoing intergenerational
cycle of abuse.
Illicit drug use was significantly associated with
younger age of onset of motherhood. This association
has been previously reported, with one US study estimat-
ing that illicit drug use increased the risk of an adoles-
cent’s involvement in teenage pregnancy by fourfold,
compared to those with no history of substance abuse
[14]. However, in some cases, teenage pregnancy may
reduce drug use. In a cohort study of 456 pregnant
teenagers, 66% of drug-using teenagers quit when they
became pregnant [15]. In the present study, 75% of illicit
drug-using teenagers quit immediately before or during
early pregnancy.
Idealization of pregnancy emerged as a theme in our
study. The majority of the teenage subgroup regarded
their pregnancies as the single most exciting and positive
event to have occurred in their lives. The finding is
consistent with previous Australian research, where the
Co-efficient (SE) 95% CI t
6.73 (1.10) 4.54–8.92 6.10
5.23 (1.24) 2.78–7.68 4.23
3.35 (0.91) 1.55–5.16 3.69
2.68 (0.44) 1.80–3.56 6.06
2.58 (0.56) 1.46–3.69 4.60
1.51 (0.39) 0.72–2.30 3.81
1.27 (0.30) 0.68–1.86 4.26
1.29 (0.51) 0.28–2.31 2.53
pregnancy was reported to be an event the teenage
mother had planned and desired. A child was believed to
provide unconditional love [16]. In one US study, teen-
agers stated that the pregnancy was a way to reconnect
with family members and it was regarded with high
expectations [4].
Low family income was a significant independent
association of teenage motherhood. The finding is
consistent with overseas research, where the associa-
tion between socioeconomic deprivation and teenage
pregnancy is strong. In a large epidemiological study
involving researchers from five developed countries,
researchers reported that having a low family income
increased a young woman’s chance of early parenting by
tenfold [17].
We observed high levels of psychological symptoma-
tology in the teenage mothers compared to older ante-
natal women. Data from the older antenatal women were
consistent with data in help-seeking Australians obtained
in the 1997 Australian National Survey of Mental Health
and Well-Being [18]. However, levels of psychological
symptomatology in teenage mothers were significantly
higher with approximately 50% and 25% of subjects
meeting the cut-off score of 7/8 for a possible case in
the HADS-A and HADS-D subscales, respectively, and
75% meeting the 6/7 cut off on the GHQ-28. We have
previously reported high rates of teenage antenatal
patients meeting one of the DSM-IV diagnoses for a
mental illness [19]. Interestingly, the HADS, but not
GHQ data remained significantly associated with age of
onset of motherhood in multivariate analysis. Of note,
despite the high levels of psychological symptoma-
tology, few mothers had received formal contact with
psychiatric or psychology services.
In the present study, poor educational attainment was
a significant independent association of teenage mother-
hood. The finding is supported by a US study, where
teenage mothers were found to complete 1.9–2.2 fewer
years of education compared with women who delayed
 J.A. QUINLIVAN, L.H. TAN, A. STEELE, K. BLACK
childbearing [20]. A second US study concluded that
having a teenage birth would result in a 50% reduction
in the likelihood of high school completion compared to
non-pregnant peers [21]. The lack of educational oppor-
tunity may result in a lack of career ambition and moti-
vation. In this study more teenage mothers were unsure
of their career objective and identified parenting as their
only future role. Perhaps it is not surprising that at a time
when their educated peers begin studying for their
‘working careers’, those with ‘mother’ as a career choice
fall pregnant.
The study has a number of limitations. Participants
were recruited from a single institution which may
impose constraints on generalizability. Although events
enquired into are highly likely to be accurately recalled,
the study includes retrospective data and the potential for
recall bias is present and this could influence findings.
While school-based educational programs and avail-
ability of contraceptives are important to help reduce
teenage pregnancy, it is likely that strategies to lower
rates of teenage births will require more complex and
multilevel interventions. These should start by identify-
ing vulnerable new parents and offering them extended
home-visiting services, parenting support and family
violence interventions to help improve the environment
into which they rear the next generation, especially over
those important early 5 years. Strategies will then need
to focus on self-esteem and reducing the idealization of
pregnancy as a solution to general life dissatisfaction,
with strategies to entice school students diverging from
educational pathways into alternative, positive career
choices that do not rely on formal education skills.
Finally, adverse psychological symptomatology in teen-
agers needs to be identified at every opportunity.
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