Pregnancy outcome among Pregnancy outcome among teenage women teenage women ...

147 Pages·2008·4.96 MB·English

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Rostock,
24. Juli 2007
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eingereicht an der Wirtschafts- und BetreuerIN
Sozialwissenschaftlichen ErstgutachterIN: Prof. Laura Bernardi
Fakultät der Universität
Rostock Zweit-GutachterIN: -

vorgelegt von: Tina Hannemann Lehrstuhl: Juniorprofessur für Ursachen
und Konsequenzen des
Matrikel-Nr.: 002201754 demographischen Wandels
Bearbeitungs-
Diplomstudiengang: Demographie zeitraum: 6 Monate
List of Figures............................................................................................................................3
List of Tables..............................................................................................................................4

1. Introduction............................................................................................................................5
2. The current fertility situation in Germany............................................................................10
2.1. Definitions.....................................................................................................................10
2.2. Current fertility situation in Germany...........................................................................11
2.3. The case of teenage fertility in Germany......................................................................15
3. Theoretical background........................................................................................................22
3.1. Physical and Biological Development..........................................................................22
3.2. Knowledge and sources of information about sexuality and contraception..................28
3.3. Pregnancy Prevention....................................................................................................33
3.4. Occurrence of pregnancy..............................................................................................36
3.5. Wanted pregnancies among teenage women ................................................................39
3.6. Abortion........................................................................................................................47
3.6.1. Introduction and history....................................................................................47
3.6.2. Current restrictions............................................................................................48
3.7. Adoption and baby drop box.........................................................................................49
4. Research questions...............................................................................................................52
5. Empirical part I: quantitative analysis..................................................................................54
5.1. Data and methodology..................................................................................................54
5.2. Results...........................................................................................................................57
6. Empirical part II: qualitative analysis..................................................................................65
6.1. Data and Methodology..................................................................................................65
6.1.1. Introduction and conditions...............................................................................65
6.1.2. Contact to the participants.................................................................................67
6.1.3. Interview guideline............................................................................................69
6.1.4. Sampling............................................................................................................72
6.1.5. Case Description...............................................................................................74
6.1.5.1. Interview 1: Gabi............................................................................................74
6.1.5.2. Interview 2: Beate..........................................................................................75
6.1.5.3. Interview 3: Petra...........................................................................................77
6.1.5.4. Interview 4: Anne...........................................................................................78
6.1.6. Methods of analyzing........................................................................................79
6.2. Results...........................................................................................................................81
6.2.1. Contraceptive use..............................................................................................82
6.2.2. First reactions to the pregnancy........................................................................85
6.2.3. Decision making process...................................................................................87
6.2.4. Family background............................................................................................91
6.2.5. Impact of the social environment......................................................................93
6.2.6. Behavior after the decision for an abortion.....................................................100
6.2.7. Behavior after the decision to bring the pregnancy to term............................101
6.2.8. Consultation offices.........................................................................................104
6.2.9. Parenthood and the life after the childbirth.....................................................105
7. Conclusion..........................................................................................................................111
7.1. Contraception use........................................................................................................111
7.2. Decision making process.............................................................................................112
7.3. Early Motherhood .......................................................................................................114
8. Discussion..........................................................................................................................116
8.1. Further research and future perspectives.....................................................................116
8.2. Adolescence and Parenthood......................................................................................116

Appendix................................................................................................................................118

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List of Figures

Figure 1: Live births (from women of all ages, 1993 – 2004)........................................11
Figure 2: Still births (from women of all ages, 1993 – 2004..........................................12
Figure 3: Abortions (from women of all ages, 1993 – 2004)..........................................14
Figure 4: Pregnancies (from women of all ages, 1993 – 2004)......................................15
Figure 5: Live birth from Teenage mothers (1993 – 2004).............................................16
Figure 6: Difference between both calculations
in total numbers by age (2000 – 2005)..........................................................17
Figure 7: Teenage still births (1993 – 2004)...................................................................19
Figure 8: Abortions from teenage women (1993 – 2004)...............................................20
Figure 9: Pregnancy among teenage women (1996 – 2004)...........................................21
Figure10: No sexual experiences at all by age................................................................23
Figure 11: First sexual intercourse in the age of 14 and
younger by kind of school.............................................................................27
Figure 12: Who were the main persons of your own sex education...............................28
Figure 13: Consulted a gynecologist (girls)....................................................................30
Figure 14: About which topics teenagers want to know more about..............................32
Figure 15: Use of contraception among adolescents.......................................................34
Figure 16: Be aware of the morning after pill by age groups and gender.......................35
Figure 17: Schematic correlation of level of pregnancy plans
and contraceptive use....................................................................................37
Figure 18: Dependencies between the four levels of the theory.....................................40
Figure 19: Adoptions (1996 – 2004)...............................................................................51
Figure 20: Distribution by age of the mother..................................................................55
Figure 21: Schema of tree coding with NVivo...............................................................80
Figure 22: Fertility related social environment of Gabi .................................................94
Figure 23: Fertility related social environment of Beate.................................................95
Figure 24: Fertility related social environment of Petra.................................................96
Figure 25: Fertility related social environment of Anne.................................................97
Figure 26: Schema of impact on contraceptive behavior of teenagers ...........................111
Figure 27: Schema of impact determinants on the decision
about the pregnancy outcome........................................................................113
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List of Tables

Table 1: Overview of the three psychological conflicts in adolescence.........................26
Table 2: Primary descriptions of an intended, unintended, planned,
unplanned, wanted, or unwanted pregnancy by Fisher et al. 1999..................38
Table 3: Distribution of live births by age groups..........................................................56
Table 4: Origin of the mother..........................................................................................57
Table 5: Employment situation of the mother (parents).................................................60
Table 6: Former pregnancy experiences and their outcomes..........................................62
Table 7: Smoking behavior of the woman (in general and during pregnancy)...............63
Table 8: Number of life births in Rostock 1996-2005....................................................66
Table 9: Number of abortions in Mecklenburg-Western Pomeranian 1996- 2005.........66
Table 10: Sampling (interview partner and failure)........................................................73
Table 11: Overview about interviewee characteristics...................................................81

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1. Introduction

Demographic change covers more and more aspects of public and private life. Although
approaches to understand the causes and consequences of the demographic development
were known since many years, this topic has become an issue in everyday life especially in
the last decade. Demographic changes appeared in nearly every industrialized country in
recent decades. The often cited “Second Demographic Transition” (van de Kaa, 1987)
focuses on changes on the European continent. The main argument of the “Second Demo-
graphic Transition” - the decrease of the birth rate under the level of the mortality rate -
became reality for most European countries. Germany, in the centre of Europe, is no ex-
ception. Without international migration, the German population would have decreased
during the last couple of years.
Fertility and mortality changes affect many different aspects of policy, economy and social
structure. People in different age groups have particular concerns of their own. One aspect,
which is one of the most current and most difficult problems in Germany, seems to be the
pension system, based on the so-called “Generation Contract”. Concerning the ageing
population it has becoming more and more difficult to manage this system. Another well-
discussed phenomenon is the new fertility situation, characterized by a decrease and post-
ponement of births in equal numbers. As the number of children is constantly decreasing,
the educational system, including schools, vocational training and university education,
needs to be reduced and restructured. Furthermore, it is becoming more complicated to
bear the double burden of employment and family formation for both men and women.
Recent policies try to encourage couples above the age of 20 to have children with many
new programs of family support (e.g. Elterngeld). These measures should prevent the
German society from obsolescence by having more children. The biological limits of fe-
male fertility are within the age period from 15 until 45 years. Furthermore this time of
about 30 years will be reduced considerably by the personal situation and social norms.
Especially for women, there is an upper age limit. Prospective there will be a time when
women are no longer able or willing to bear and raise children. Modern medicine made it
possible to bear a child up to the age of 40 and even older. But younger women seem to
have the greatest advantage for this life event, concerning biological and medical condi-
tions (Morris, 1981). While the upper age limit is determined by biological restrictions the
lower age limit is defined by current moral conceptions. Women are able to conceive at the
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age of 15 and sometime even younger. In contrast the age group of women under 20 seems
to be disregarded by the political supporting programs. General public opinion suggests
that every pregnancy at this age means a catastrophe and should be prevented for these
young women. This fact is also reflected by the public media, which draws attention to
extreme cases (e.g. Hamburger Abendblatt „Luiza (12) - Deutschlands jüngste Mutter“, 2.
März, 2006). This produces the impression of a fast rising group of young pregnant women
and teenage-mothers. Presenting one or two pictures of very young mothers with their
children in newspapers provokes the public into believing a fairy tale of a teenage-
pregnancy-epidemic in Germany. This negative influence of the media, considering the
topic of teenage pregnancy, is also mentioned by Gille (2002) and in a research protocol of
a project concerning teenage pregnancies in Germany from the charitable organization
Pro.familia (Thoss & Schmidt, 2006). It seems that nobody wants to hear or believe that
this phenomenon is not escalating and in fact relatively rare in Germany compared to other
European countries as England for example. While the public reaction to the event of
teenage pregnancy is mostly compassion and the belief that such events are only possible
in lower social classes, the policy are concentrating on the numbers concerning welfare
cost. Moore and Burt give a complex perspective about these two dimensions in their book
“Private Crisis, Public Cost: Policy Perspectives on Teenage Childbearing” (1982), focus-
ing on the US situation in the 1970s. Most of their arguments are still currents problems.
Scientific research discovered the subject of pregnant teenagers, its reasons, consequences
and possible solutions in the middle of the 1960s. The USA, as the country with by far the
highest rates of teenage pregnancies in the industrialized world, then, as well as today, was
entering this sphere of scientific discussion at first. Research on the topic of teenage preg-
nancy, their determinants and consequences, had many different aspects. In the following, I
will present some of these aspects and results from scientists, dealing with the topic of
pregnancy and motherhood in early ages.
When talking about the reasons why teenagers became pregnant, although the availability
and access to contraceptives is on a high level, even for adolescents, one can argue that
young people are associated with more risk-taking behavior than adult people. Hoggart
(2006) recognized in her qualitative study that young women are confused about their own
intentions and the possible consequences of their action. Additionally young women still
struggle to negotiate “risk-free” sex with their sexual partner. Luster and Small (1994)
divided the group of teenagers (age 13-19) into groups of different risk degrees and tried to
figure out factors which influence risky behavior. They distinguished that there are com-
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mon impacts for female and male adolescents, like alcohol or drug consumption or a low
level of parental support and monitoring. There are also gender specific factors, for exam-
ple the authors found the aspect of a lack of communication between mother and daughter
about birth control as strong risk supporting factor. The same trend was not found for male
teenagers.

Furstenberg, Masnick and Ricketts (1972) were determining the effect of family planning
programs on adolescents’ behavior, concentration on the delay of the second birth of young
women. They emphasize that long-term programs have the best prospects of achieving
long-term results. Likewise Frost and Darroch (1995) were dealing with the effectiveness
of family planning programs. They compared 5 special teenage pregnancy prevention
programs and their results. The authors mentioned that even when all five programs had
positive effects (delaying the initiation of sexual activity and contraceptive use among
sexual active teenagers), there was still a big potential of development of such programs.

One of the most important aspects of consequences seems to be the medical benefits or
disadvantages from early pregnancy. In the scientific literature there are controversial
opinions and different foci concerning this topic. Siegel (1963) argued that the adolescent
mothers have more medical problems (higher risks of toxemia and anemia) because of
their premature bodies and bad nutrition. In 2004, Drife underlined the medical disadvan-
tages of children from teenage mothers. Moore and Wertheimer (1984) analyzed the wel-
fare costs of teenage childbearing by giving computer simulation supported forecasts.
Adolescent mothers and couples depend much more often on welfare and social support
than other people because of their incomplete educational careers. A reduction of the fre-
quency of teenage childbearing means that more young people are becoming economically
independent and do not have to rely on the welfare system.
Moore et al. (1993) concentrated on the economic consequences of early motherhood.
Because of low educational attainment and low marital stability, coupled with the poverty
endemic to young parenthood, teenage mothers have lower incomes as adult mothers and
are more likely to be dependent on welfare than their peers who delay childbirth. Hoffman,
Foster and Furstenberg (1993) encourage this argument with own data. Comparing a set of
sisters they were showing that a teenage birth nearly double the likelihood that a woman
would be poor at ages 21-33.
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Whereas the focus of the discussion varied a lot, the consequences of teenage childbearing
seems to have no positive aspect referring to the literature. Consequently there exists a
meta-message among the scientific research on teenage pregnancy:

Teenage pregnancy and motherhood is something that should be avoided.

In this study, I would like to focus on the situation of pregnancies, births and abortion
among teenage women in Germany. I will try to combine quantitative and qualitative data
to give an impression from both the macro and micro perspective. The statistical data helps
to explain the general situation and will provide a good overview about the events of preg-
nancy, birth and abortion among adolescents who are younger than 20 years. The qualita-
tive analysis, using personal semi-structured interviews, goes a step deeper into the topic.
Getting answers from teenagers concerned about their experiences, intentions, fears and
problems should clear up the picture of a homogeneous group. This study should help to
get familiar with the topic in general, regarding the scientific discussion and especially the
German situation.
In the following chapters I will analyze the phenomenon of teenage pregnancy among
German women in different ways. In the first chapter, I will show the general fertility
situation in Germany. I will give an overview on the current legal situation and some defi-
nitions concerning pregnancy and childbearing. Following, I will present the fertility situa-
tion referring only to adolescents, women under the age of 20.
In the subsequent chapter I will deal with the theoretical framework of fertility in adoles-
cent age. International and German scientific literature will be presented and compared.
Different aspects and intervention possibilities will be applied to the German case. I will
try to explain the social and psychological reasons of teenage pregnancies and the conse-
quences of different pregnancy outcomes. To conclude the theoretical part, I will present
my research questions for the study, developed from the theoretical framework and the
current fertility situation in Germany.
Using the preparation of the theoretical chapter as a base, I will start with the first empiri-
cal part of the study. Data and methodology will be explained in the following and the
results from the quantitative analysis will be presented.
The subsequent chapter which is the focus of this study will deal with the qualitative em-
pirical analysis. Methodology, data selection and analyzing tools will be explained, fol-
lowed by the results of the semi-structured interviews.
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In the last chapters, I will summarize the results from the qualitative interviews and from
the analysis of the quantitative dataset. Using the theoretical framework presented in the
literature review, both analytical parts will be connected with each other. During the con-
clusion all research questions from the third chapter will be answered. Furthermore, I will
discuss some recommendations and present a possible future perspective for the German
case.

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