What’s the Story? Views of Pregnant Teens in Qualitative Research

Abstract

Despite declining birthrates, teen pregnancy is still seen as an “epidemic” centered among low-income young women of color. Professional, conservative, and social justice views of the “problem” vary greatly. This article reports on the first findings from a systematic review of qualitative studies from 1989 to 2014. Forty-one studies were identified, and the narratives in them varied. Variation in perspective was related to the profession of the study author and whether the author professed a feminist and critical race perspective. Findings inform theory, practice, and policy.

While social and cultural norms regarding nonmarital sex and single motherhood have changed greatly in recent decades, teenage pregnancy and childbearing are still viewed as a significant public health and social problem. The prevention of teen pregnancy, the choices a young woman makes when she becomes pregnant, and, when she chooses to give birth and keep her baby, how best to support success for both mother and child have all been distinct and complex areas of study. Despite this proliferation of research, controversies, both professional and political, surround this “problem,” likely because women’s sexuality and reproduction remain an area of social and political control efforts (Ginsburg & Rapp, 1991).

Teenage pregnancy and parenting as a distinct social problem have been studied intensively since the early 1970s, and qualitative studies, which emerged later than quantitative ones, generally sought to “give voice” to the young women who constitute the problem. This qualitative research has uncovered new perspectives on teen pregnancy and parenting. Included among them is the discovery that embarking on pregnancy and anticipating motherhood often leads young women to “clean up their act.” Another discovery from an Afrocentric perspective has been that becoming a mother can be a rational route to attaining adult status and independence for young women who do not have the educational and economic advantages that more affluent teens do (Stevens, 1994, 1996; Williams, 1991). However, despite falling numbers of births to teens in the United States in recent decades, the dominant discourse about teen pregnancy has been one of an “epidemic” and serious public health problem that requires vigorous prevention efforts.

This article describes the first findings from an ongoing systematic review and synthesis of qualitative studies of teen pregnancy over a 25-year period (1989–2014). The focus of this analysis is the “stories” told by study authors on the problem of teenage pregnancy, using Kelly’s (1996) typology of narratives about teen pregnancy. The nature of each publication (article, book, dissertation), date of publication, and the country where the research was conducted (United States or other), and the disciplines of the first authors of each study are also presented to contextualize the findings.

Kelly’s (1996) study of media accounts of teen pregnancy and childbearing was the first to draw attention to the varying narratives used to describe and discuss the problem. “Narrative both ‘makes’ and ‘does’ identity; social narratives generally position teenage pregnancy and childbearing as “an indisputable pathology and exigent social problem” (Barcelos & Gubrium, 2014, p. 467). While there is a dominant “expert” view of the problem, research can be based in differing points of view or stories of teen pregnancy, which in turn result in differing conclusions and recommendations for intervention.

Literature Review

Teen Pregnancy and Childbearing in the United States

The last 25 years have seen marked changes in social policy, social provision, and professional views of adolescent pregnancy. Arney and Bergen (1984) date the “invention” of teenage pregnancy as a social and scientific problem to about 1970. In the United States in the 1980s, concerns about teenage pregnancy and parenting emphasized its results in long-term Aid to Families with Dependent Children (AFDC) “dependency” and even that access to AFDC (or “welfare”) was causing teens to get pregnant (e.g., Klerman, 1993). Because of these concerns, the “welfare reform” legislation enacted in 1996, the Personal Responsibility and Work Orientation Act (PRWORA), in addition to its general time limits and work requirements, has specific provisions affecting teens receiving Temporary Assistance to Needy Families (TANF). The language of the legislation mentions “reducing illegitimacy” by not providing additional benefits to children born subsequently “out of wedlock.” As to adolescents specifically, the TANF program requires states to place “special emphasis” on the prevention of pregnancy among teens while limiting its support for “prepregnancy family planning” to abstinence-only models. In addition, “minor teens” who are pregnant or parenting are required to live in “adult supervised settings” and to stay in school, but there is no childcare provision in the program (Levin-Epstein, 1996).

This characterization of teenage pregnancy as an epidemic problem continued into the early 2010s even as the rates of adolescent childbearing have been declining in the United States for some years, reaching a historic low of 24.2 per 1,000 women in 2014, a drop of 9% from 2013 (Centers for Disease Control and Prevention [CDC], 2016). Rates have also been falling in the UK, but in both countries, the rates of teenage pregnancy and childbearing remain higher than in other wealthy nations. Adolescent girls who are receiving or have received child protective services become pregnant and young mothers more often than others (e.g., Connoly, Heifiez, & Bohr, 2012). Their meta-analysis of studies focusing on that group found that while these young women may talk about an infant filling an emotional void, some see mother as “positive and stabilizing” as they mobilize their “internal strengths” and social supports to “do better” (p. 614).

In the United States, there are significant disparities in early pregnancies and birthrates among teens: “Non-Hispanic Black youth, Hispanic/Latino youth, American Indian/Alaska native youth and socioeconomically disadvantaged youth of any race or ethnicity experience the highest rates of teen pregnancies and childbirth” (CDC, 2016, unpaginated). Birth outcomes vary across these racial/ethnic groups, and poverty is known to be associated with less prenatal care and poorer birth and developmental outcomes in all racial/ethnic groups. Hence, the problems of teen pregnancy and childbearing have been racialized, with concern directed at the “bodies of poor women of color” (Barcelos & Gubrium, 2014, p. 468).

The standard description of teen pregnancy in the United States and Great Britain as an epidemic or exigent public health problem has been contested. Those who regard teen pregnancy as a public health problem point to higher health risks in this group including later entry into prenatal care, infant prematurity, and a higher rate of child maltreatment (e.g., Payne & Anastas). Indeed, recent data show that birth outcomes among adolescents are poorer compared with women a few years older (Kaye, 2012). Others counter that it is the poverty and marginalization of these young families that is most damaging, not the age of the mother (Bonnel, 2004; Klerman, 1993; Koffman, 2012). Teens themselves point out that there are good and “bad” mothers in all age-groups and that there are advantages to being a young mother while young, such as having energy for the role. In addition, Clemmens (2003) concluded that “adolescent motherhood can be positively transforming” (p. 97).

It is also known that teen pregnancies are more common among low-income teens (Klerman, 1993; Koffman, 2012) as well as among young women who are or have been in child protective services (Connolly, Heifetz, & Bohr, 2012; Knight, Chase, & Aggleton, 2006). One way to summarize this situation might be that these pregnancies, especially those that result in birth with the young mother proceeding to “keep” the infant, are most common among young people who are already marginalized. In addition, “governmental concern with teenage motherhood can be seen as…another instance of problematizing working class fertility” (Koffman, 2012, p. 121), as “race…intersects with class…engendering social unease” (p. 121).

Narratives About Teen Pregnancy and Childbearing

A feminist scholar, Deidre Kelly (1996), has identified three differing narratives on the subject. ¹ The first and most common “story” is that something is wrong with the girl, whether that be lack of knowledge about how to prevent an unwanted pregnancy, immature expectations of what being a mother is going to be like, past or present trauma including sexual abuse, as in Renker (2002), and other psychological problems. This discourse of bureaucratic experts locates the problem in the young women themselves: needing someone to love them, having abusive or traumatic experiences, or simply making a “tragic mistake.” This view encompasses the “babies having babies” framework that holds that be developmental definition, now seemingly buttressed by brain research on adolescents (Casey, Getz, & Galvana, 2008), that a “child” cannot adequately function as a responsible adult with respect to healthy behaviors during pregnancy nor successfully mother an infant or growing child. The view of teen pregnancy as a public health problem also fits here. Rains, Davies, and McKinnon (1998) call this the “correctional perspective” (p. 429). This professional story about teen pregnancy leads to calls for prevention, monitoring, and treatment efforts aimed at individual change. Kelly sums this framework up: “The wrong girls are having babies” (p. 429). This stigma story is labeled “Type A” in this study.

Kelly’s second story, called Type B in this study, is that teen pregnancy and childbearing result in making the “wrong kind of family.” This conservative story rests on the idea that the girl’s family of origin or her “subculture” failed to convey “good” values about sexuality and preferred family forms (e.g., heterosexual adult marriage prior to procreation). The underlying worry is often “concern over the fate of the nuclear family” (Kelly, 1996, p. 431). One example of an area of inquiry arising from this point of view is about unmarried teen motherhood in the teens’ own mothers or sisters. While Type B narratives may be only subtly expressed in most current professional discourse about pregnant teens, it is commonly expressed in public policy, as the TANF example above illustrates, as well as in journalism, politics, and other forms of public discourse. This normative and moralistic point of view on unwed motherhood has been dominant historically (Kunzel, 1993; Lewis & Welshman, 1997), remains among the “bundles of norms” that teens perceive in public and private messages about teen pregnancy and motherhood (Molborn & Sennott, 2014), and can be reflected in the middle-class values of professionals serving these teens (Rutman, Strega, Callahan, & Dominelli, 2002).

The third point of view used in this analysis is the category that Kelly describes as “dissenting views,” largely advanced from feminist, Afrocentric, and other critical standpoints: “An anti-racist, feminist ideology…would point to the gender and racial subtexts in the dominant discourse about teen mothers” (p. 424). Part of this dissenting story is about the ways in which teens who bear and rear their children do so in the face of social structural barriers. One example is school disaffection, which usually starts before the pregnancy. In addition, pregnancy status and race are barriers to employment. And the limited employment opportunities available in communities of color—low wage, contingent jobs without benefits—are additional structural factors influencing the situation. Pregnant teens are often aware that pregnancy and parenting themselves become barriers to getting a job (Payne, Anastas, & Ghuman, 2016). Among other points, these dissenting views also call for supporting all young women’s decisions about sexuality and reproduction, including those who decide to become young mothers. Those telling this story—called Type C narratives in this article—advocate for organizational reforms (e.g., in schools) and social reforms to address structural barriers as well as less stigmatization of these young women.

Kelly says the following: “the discourses do not compete as equals; some carry little weight and are marginalized, whereas others are considered authoritative and dominant” (p. 423). Counting the number of studies reflecting each of the three narrative types will suggest which narratives are dominant in this particular body of research. Kelly also sees them as “fram{ing} the public debate about teen mothers…shap{ing} the debate about public policy, and…infuenc{ing} the daily lives of young mothers and their children profoundly” (p. 444). There is also evidence that programs for pregnant and parenting teens are informed by and based on very different perspectives on or “narratives” about what is most needed (Rains, Davies, & McKinnon, 1998). Rains et al. described programs in one city emphasizing care for the teens themselves (group residence), another seeing them as problematic mothers by providing better care for their babies by providing nursery services and parenting classes (a community-based agency), and a third that worked toward empowerment: a teen-run drop-in center that emphasized mutual aid and advocacy for better services and policies. Hence, the narratives frame service provision as well making each study’s recommendations for needed services and/or policy recommendations useful for classifying narrative types.

Feminist Perspectives

While there are many feminisms, it can be argued that all of them employ a gender analysis to understand the lives of women (and men). Feminism understands that women in most societies are oppressed and marginalized as a result of deeply held gender ideologies, identifying the many ways in which human potential and social life are diminished as a result. Feminists often question standard views of view of social policy, social provision, and how “personal troubles” become social problems. Placing concerns about teen pregnancy in the broader context of the social control of women, especially the control of women’s bodies with respect to sexuality and reproduction, Ginsburg and Rapp (1991) observe that the greatest rise in birthrates in recent years in the United States has been in births to unmarried older women. Just as with teen pregnancy, risks to the infant, other pregnancy complications, and risks to the mother are high in this group, and these pregnancies, like those in teenagers, are defined as “high risk.” However, there does not seem to be an interest in preventing them or in seeing this trend as a public health problem despite the high medical costs associated with these pregnancies. This form of reproduction is most common among affluent white women, while rates of teen pregnancy are higher among black and Latina young women than they are among white teens.

In addition, feminists are usually interested in “giving voice” to women, supporting their agency, and empowering them, making qualitative research appealing to many. Therefore, researchers employing a feminist perspective to understanding teen pregnancy might be more likely to support the “bad society” view of teen pregnancy (Kelly, 1996). Hence, this review focused on qualitative research and also notes when a study author stated that a critical perspective—feminist and/or Afrocentric—informed the research, which was expected to make it more likely that the study might take a Type C or social change perspective.

Study Method

Qualitative research in social work has proliferated since the 1980s, also becoming more common across disciplines on the topic of teen pregnancy and parenting. These qualitative studies are designed to elicit the views of pregnant young women to illuminate their feelings and circumstances. There are previously published reviews of qualitative research on parenting teens. Spear and Locke (2003) conducted a narrative (not systematic) review of 22 qualitative studies, addressing teen pregnancy and parenthood published as journal articles from 1990 to 2000; Clemmons (2003) limited her review to studies of parenting teens that were published in the nursing literature between 1990 and 2000; Connolley, Heifitz and Bohr (2012) included only studies of teens involved in child protective services. The present review, while limited to pregnant teens, updates and expands upon them by including sources other than peer-reviewed journal articles, is not limited to those cited in the nursing literature; does not exclude studies of teens in care but includes studies of others as well; and uses more current, rigorous, and ever-evolving methods for conducting systematic reviews of qualitative studies (Little, Corcoran, & Pillai, 2008; Saini & Shlonsky, 2012). One of these methodological requirements is inclusion of studies that may not appear in peer-reviewed journals in an effort to reduce publication bias in findings reported.

For a variety of reasons, there are many more studies of teens who are already mothers than of teens who are pregnant. Teens may come late to acknowledging the pregnancy or seeking prenatal care, so that the time they are known to any health, social service, or educational program before they give birth can be limited. Since their motherhood is usually an enduring state, the recruitment of young mothers to research studies is easier. The focus was on teen pregnancy for two main reasons: (1) pregnancy is increasingly seen as a time in which biological and psychosocial risks to the mother and the unborn child can be mitigated and (2) it is the more understudied area compared to teen motherhood. The reason for focusing on qualitative research is that Kelly’s (1996) “dissenting views” and the views of the teens themselves, which are the least common perspectives represented in media and professional accounts of the problem, are most likely to be found in qualitative research. In addition, at the time of this review, the author was involved in a mixed methods study involving low-income, urban pregnant teens and therefore sought more knowledge on the topic from prior qualitative research (Payne & Anastas, 2014).

Literature Search and Retrieval Process

The methodology used in this systematic review was based on Saini and Shlonsky’s (2012) text on conducting systematic reviews of qualitative research and synthesizing study findings. First, the author searched nine databases over a 6-week period: Social Services Abstracts, Social Work Abstracts, Sociological Abstracts, JSTOR, MEDLINE, CINAHL, Embase, Dissertation Abstracts, and Contemporary Women’s Issues. Based on the review of titles and then, if promising, abstracts, all but the last database yielded citations to potentially usable documents. ² The process included an unsuccessful experiment with the SPIDER search method (Cooke, Smith, & Booth, 2012), which proved less efficient than the terms already in use. Main search terms were (1) “qualitative research” or sometimes “research” followed on a second line by “qualitative,” and (2) “teen pregnancy” or “adolescent pregnancy.” When a database permitted further checkoff specification, the search was limited by publication date to 1989–2014 and to English-language documents. In addition, journalism, “pamphlets,” film reviews, and software reviews were excluded, and dissertations, conference papers and proceedings, journals, and books were included.

Additional inclusion criterion

Use of these search terms always yielded studies of teen mothers, but the phrase was not used as an elimination term because some studies that included both groups (pregnant and parenting) were acceptable. Studies of teen mothers have suggested that their points of view on the pregnancy often change after the birth of the baby (e.g., Spear, 2004a), so it was decided to focus in this review on the pregnancy period. Studies focusing on pregnant teens up to 19 years of age were included. While it might have been simpler to include studies with only pregnant teens in the sample, the goal of a systematic review is to be as inclusive of data sources as possible.

Exclusion criteria

In reviewing the documents identified in these searches, there were several exclusion criteria applied by review of titles, abstracts, or article texts: studies with quantitative data only, although mixed methods studies were included; research done overseas EXCEPT that studies in the UK, Australia, New Zealand, and Canada were included; studies of teen mothers only, although studies including both groups were included unless the number of pregnant teens included in the sample was very limited (e.g., n = 1); retrospective studies (adults or parenting teens recalling teen pregnancy); studies specific to repeat pregnancy, pregnancy prevention, and sexual readiness with samples other than pregnant teens themselves were also excluded. Rather, the focus in this review was on the social and psychological states and situations of pregnant teens as described by them during the pregnancy.

Studies initially identified

The unduplicated number of eligible studies originally identified in this process was 37. Backward and forward searching from these added to the total.

Backward and Forward Searching

The next step in identifying studies for inclusion was to search the reference lists of the 37 publications found in the initial database search (backward searching). This search yielded nine additional unduplicated studies that were then included in the review. Forward searching (finding studies that cited any of the journal articles in the list of 35 studies) was done for all 23 journal articles listed in the original 35 studies; information was gathered on each article from their journal websites and from the Science Citation Index. Three additional qualitative studies were identified from this process, which took place over 3 weeks, with two more eligible studies identified through backward searching after that time. This brought the total number of documents identified to 51.

Further Elimination

Despite care in reviewing titles and abstracts when identifying these 51 studies, during the data analysis 5 were eliminated because the samples described in the studies, in contrast to what was suggested in the study abstracts, did not meet inclusion criteria or because no data from pregnant study participants appeared in the findings. Similarly, five more studies were eliminated because they did not contain usable qualitative information or were found not to meet the inclusion criteria in other ways (e.g., only retrospective accounts of pregnancy). This brought the number down to 41 studies that were usable for this analysis (see Table 1). A diagram of this process following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines is available from the author upon request.

Table 1.

Qualitative Studies of Pregnant Teens and Their Narratives.

Date of Publication	Authors	First Author Discipline	Title Source	Narrative Type	Sample	Selected Qualitative Themes
1991	Weber, J. R.	Education	Young pregnant teens’ perceptions of themselves and their relationships with their families and male partners DISSERTATION	A Theory of problem versus conventional behavior in teens	N = 10 Ages 14–15 Seven white, three black	SELF—academics, activities, feelings, self-esteem (determined to succeed), previous problem history MOST IMPORTANT IN YOUR LIFE: baby, family, school (top three). FEELINGS ABOUT LIFE: upbeat re family, baby, alternative school, welcome responsibility FUTURE: schooling, careers, child care, family live with, partners CHANGES FAMILIES: types, values, expectation of parental support PARTNERS SIMIARITIES AND DIFFERENCES among and re literature
1993	Custer, M.	Nursing	Adoption as an option for unmarried pregnant teens Adolescence, 28(112), 890	B “teens showed no shame in embarking on single motherhood”	Mixed sample N = 21 White	Most important: the absence of societal sanctions against adolescent parenthood, concurrent with reciprocal sanctions against relinquishing a child for adoption; “Stark lack of knowledge” about adoption among teens (knowledge phenomena) Professionals’ failure to provide enough information about adoption (contextual phenomena) Anticipated psychological discomfort (belief phenomena) “The baby would hate me for making him go through such a thing; hate me because I wasn’t there to love him.”
1993	Spry, P. K.	Nursing	Unplanned pregnancy and parenthood in African American adolescents: Paying to play DISSERTATION	A	African-American teens aged Ages 12–17 N = 23 Low income	SELF—academics, activities, feelings, self-esteem (determined to succeed), previous problem history MOST IMPORTANT IN YOUR LIFE: baby, family, school (top 3). FEELINGS ABOUT LIFE: upbeat re family, baby, alternative school, welcome responsibility FUTURE: schooling, careers, child care, family live with, partners CHANGES FAMILIES: types, values, expectation of parental support
1993	Sternberg, L., and Blinn, L.	Family studies	Feelings about self and body during adolescent pregnancy Families in Society, 74, 282–290	A Problems = developmental unreadiness, poor body image from weight gain, low self-esteem as problems to address during pregnancy	N = 14 Drawn from school-based teen parenting program Idaho 13 white 4 in residential or foster care	Affective qualities of diary writings (2 points in time) Self: “edgy, worrying, depressed, lonely, moody” “stupid ignorant person” Also mood swings Body: “fat, huge, ugly” “unhealthy, fat, icky” concern about stretch marks (p.285) Stability: Low. Feelings variable over time
1994	Schofield, Gillian	Social work	Book: The youngest mothers: The experience of pregnancy and motherhood among young women of school age. Aldershot, England: Avebury Press	C Feminist Motherhood valorized but not for the young	UK Mixed N = 13, N = 2 pregnant From special school program	Themes from 2 chapters of findings on pregnancy Children as parents: experienced daily contradictions in how treated; they: age not the issue Separate or connected: stay in relationship w mother or mother-in-law— Motherhood—dead end, ideal state or developmental process? Negative stereotypes and the need for anti-discriminatory practice
1995	Lee, S., and Grubbs, L. M.	Nurse	Pregnant teenagers’ reasons for seeking or delaying prenatal health care Clinical Nursing Research, 4(1), 38–49	A Not getting prenatal care in first (or second) trimester What are “subjective reasons for this?”	49 Pregnant adolescents or within 2 days of delivery Either early (14 weeks) or late (28 weeks) entrants to care Florida African-American = 27; White = 14; 8 Hispanic	Early and late contrasted throughout Decision to seek care Early—family (mother) support to do so Late—afraid to tell mother Recognition of the pregnancy All said missed period Lack of morning sickness, breast soreness, as the trigger Perceived access and barriers to care
1997	Oxley, G. M., and Weekes, D. P.	Nurse	Experiences of pregnant African American adolescents: Meanings, perception, appraisal, and coping Journal of Family Nursing, 3(2), 167–188	A From an Afrocentric and “life-span “perspective	N = 21 pregnant AA teens ages 13–19 Clinics and physician offices—California	Meaning of pregnancy Disclosure stressful Role transformation: (a) increased maturity (b) balancing school with pregnancy (c) in “wanting baby” group, “something I made” Something of my own to love Appraisal and Perception of Pregnancy Differed if pregnancy was described as “easy” or “hard” “hard” included complaints about stigma Supports—mom and/or boyfriend Support = need fulfillment Coping: physical, cognitive
1997/2002	Renker, P. R.	Nurse	“Keep a blank face. I need to tell you what’s been happening to me.” MCN (Maternal and Child Nursing), 27(2), 109–116 DISSERTATION 1997	A Problems lie in past or ongoing abuse	N = 40 who screened positive for abuse out of 139 18 Abused only before pregnancy 22 Before and during	1. Seeking safety w varying results 2. Losing faith—Negative responses 3. Experiencing loss and fetal loss 4. Living on the edge (drug use) 5. Taking next steps 6. Crying for help via suicide attempts Loss of relationships
1998	McCormick, L. L.	Public administration	Pregnant and parenting adolescents’ perceptions of prenatal care: Factors influencing use. DISSERTATION	A	Mixed method Focus groups N = 36; mixed races; Albany area; 17 parenting, 19 pregnant	Focus on prenatal care—too many themes to include Overall teens reported positive and negative experiences w. prenatal care providers; valued the care; cost and convenient access a problem. Macro and micro factors mentioned but micro emphasized via methodology.
1998	Rawlings, M. M.	Sociology	Reconstructing identities: The utility of adolescent pregnancy. DISSERTATION	C Feminist; addresses intersectionality of gender and race	Ethnography Four intensive case studies AA pregnant teens Observations of 24 teens in “pregnant school”	Structural factors AND agency Locates problem in need to control black female bodies, reproduction in particular Colorism a theme—light-skinned teens were desirable: “spoiled identity to the social type of dark black mother” “The reproductive liberty of African American women is continually under assault.
1998	Lesser, J., Anderson, N. L. R., and Koniak-Griffin, D.	Nurse	“Sometimes you don’t feel ready to be an adult or a mom”: The experience of adolescent pregnancy Journal of Child and Adolescent Psychiatric Nursing, 11(1), 7–16	A Teens’ responses to a prenatal class offering education for motherhood	N = 36 Four focus groups of 9 Participant observation	Focus on prevention through better understanding of teens’ use of contraception and decision-making re continuing the pregnancy Three main themes:  Responsibility  Respect  Reparations
1998	Mackey, M. C., and Tiller, C. M.	Nurse	Adolescents’ description and management of pregnancy and preterm labor Journal of Obstetric, Gynecological, and Neonatal Nursing, 27(4), 410–419	A Focus is reducing risk for premature delivery	Eight black, five white all hospitalized for preterm labor	Responding to pregnancy  Reactions to learning they were pregnant; pathologies in all added to risk of preterm labor Responding to preterm labor  Only some identified symptoms for what they were; most had an idea of cause, often stress emotional and physical Consequences of preterm labor  Five denied or minimized effects, 8 understood the dangers of early birth Complaints about hospitalization Managing postdischarge (n = 7)  Easy for 7 with good support at home
1999	Ivey, J. B.	Nursing	“Good little girls”: Reports of pregnant adolescents and those who know them best Issues in Comprehensive Pediatric Nursing, 22, 87–100	A A health and developmental problem for teens and their infants “identity foreclosure”	N = 8 dyads Interviewed at home, ages 16–18 Six unmarried teens, seven living with mothers Four African American, Four white	Responding to pregnancy  Reactions to learning they were pregnant; illnesses in all added to risk of preterm labor Responding to preterm labor  Only some identified symptoms for what they were; most had an idea of cause, often stress emotional and physical Consequences of preterm labor  Five denied or minimized effects, 8 understood the dangers of early birth Complaints about hospitalization Managing postdischarge (n = 7)  Easy for seven with good support at home; two had difficulty
2000	Brubaker, J,	Sociology	Medical, moral and local meanings: How teens make sense of pregnancy and create positive identities	A Symbolic interactionism: Account/meanings/interactions/self	N = 52 8 first pregnancy	Informal pregnancy care (birth skipped) Receiving pregnancy care Becoming pregnant: “webs of meaning” in each real MEDICAL—prevention and care MORAL—stigma LOCAL—street culture (use of weapons mentioned)
2000	Montgomery, K. S.	Nursing	Creating consistency and control out of chaos: A qualitative view of planned pregnancy during adolescence Journal of Perinatal Education, 9(4), 7–14	A “disaster for both” planned pregnancy to reduce chaos in their lives Planned pregnancy needs to be considered even if report is of “accidental” pregnancy adolescent issues include control needs, invulnerability, present orientation and meaning “reformed behavior” finding was a surprise	N = 8 interviewed at prenatal clinic, ages 14–17, planned this first pregnancy, unmarried	Four need themes: circumstances needed to consider an intentional pregnancy criteria (age and boyfriend) planning w boyfriend environmental needs stability Four “want” themes (reasons for wanting a baby hence planning a pregnancy) be or perceived as more grown up history of wanting maternal role nothing else to “call one’s own,” something to care for and love next natural step in life or in boyfriend relationship Others: environmental issues, adjustment to reality of pregnancy Increased motivation to do well in school and in life
2001	Montgomery, K. S.		Planned adolescent pregnancy: What they needed. Issues in Comprehensive Pediatric Nursing, 24, 19–29		All subsequent articles are partial reports of findings from the same study. Methods, narrative type and themes remain the same.
2002	Montgomery, K. S.		Planned adolescent pregnancy: What they wanted Journal of Pediatric Health Care, 16, 282–289
2004	Montgomery, K. S.		Planned adolescent pregnancy: Themes related to the pregnancy. Journal of Perinatal Education, 13(4), 27–35
2000	Cassata, L. C.	Nursing	Utility maximization and adolescent pregnancy DISSERTATION	C Rational decision-making—utility and costs	N = 22	Nondeficit perspective in re cost–benefit approach, partially supported Marriage has less “utility” than before Nurses need to attend to the environmental context
2001	Pieve, L.	Unknown	An ethnographic study of the perceptions of Puerto Rican pregnant teenagers DISSERTATION	A Immigrations stress	Ethnography Multiple informants N = 6 from school, 5 via snowballing Case studies, relevant others	One set of findings gave description of the low-income neighborhood that all came from Themes: parental loss, emotional stress at time of disclosure, subsequent family support, Puerto Rican culture: value on virginity (shame to family), family honor, duty to care for family members All NEW arrivals, Spanish speaking Focus on the social situations of Puerto Rican immigrant teens
2003	Luttrell, W.	Sociology of education	Pregnant bodies, fertile minds: Gender, race and the schooling of pregnant teens. New York: Routledge Epigram: DuBois real question: “How does it feel to be a problem?”…being a problem is a strange experience”	C Lens is race, class, and gender Stigma management a theme	N = 49 over 6 years Alternative school for pregnant and parenting teens	From girlhood to motherhood: “the-self-which-I-might-be” Showing and telling “pregnancy stories” “Body smarts” in both senses of the word: smart/clever and smarts—it hurts Purple ball illustration: Heavy and can’t move (the self is only the ball—no other features). Purple is for independence, which she will now have to achieve Schooling is separate but unequal
2003	Rentschler, D. D.	Nurse	Pregnant adolescents’ perspectives of pregnancy MCN, 28(6), 377–383	A Findings are used to develop recommendations on nursing care for pregnant teens	N = 20 19 of 20 were white 2nd or 3rd trimester referred from school or clinic nurses	Pregnant me—unexpected changes: Past—seeking fun, now different; more goal-oriented re education and employment; even emotions changed—better “attitude” Some quit bad behaviors, tried “eating healthy” Transformed relationships—More supportive adults at school; lost peer relationships Role of FOBs questionable; Relationships with their mothers often improved Envisioning motherhood: “Awesome responsibility”; being loved by the baby; wanted things for baby to be better than they had Only 2 had sought information on baby care
2004	Lloyd, S. L.	Nurse	Pregnant adolescents’ reflections of parental communication Journal of Community Health Nursing, 21(2), 239–251	A Some hints of blaming “dysfunctional families” for the pregnancy in the first place	N = 30 Predominantly Hispanic Southern California One alternative school, 3 private prenatal clinics Ages 14–19	Seven themes  Lack of communication with mothers  Lack of communication with fathers  Unstable family situations, that is, father in prison, not living at home  Prefer to share good news (versus a teen pregnancy—“parents should be happy”)  Pregnancy improved communication  Support came from others (sister, boyfriend)  Ambivalent re positive plans for the future goals short term
2004b	Spear, H. J.	Nurse	Personal narratives of adolescent mothers-to-be: Contraception, decision-making, and future expectations Public Health Nursing, 21(4), 338–346	A	N = 8, alternative school 7 black, 1 white Ages 13–19	Contraceptive behavior and attitudes Decision-making (pregnancy resolution) Expectations for the future Common reports by teens of fighting pre- and post-pregnancy
2005	Logsdon, M. C.	Nursing	Social support during adolescent pregnancy: Piecing together a quilt Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(5), 606–614	A Identifying the social supports of pregnant teens Stated feminist viewpoint of hearing the “voices” of the teens	N = 30 Recruited from pregnancy classes at alternative school 19 black, 10 white, 1 Asian	Supports. Mothers primary for (almost) all. Liked when baby daddy supported their self-care. BD’s mothers sometimes helped; changing friends to helpful ones Variation by age  13–14—moms help them retain some childhood  15–16—most ambivalence about baby daddies. Anticipated long road to getting back on track  17–18—wanted support for college and/or work Advice (stay positive, put baby first, talk to someone Context variables discovered Family composition, SES, safety issues (violence in neighborhoods, school and at home), relationship to baby daddy (baby daddy’s life didn’t have to change) Studying age differences implies importance of “child development” Overall finding is of resilience in teen mothers
2006	Coleman, L., and Cater, S.	Physician	“Planned” teenage pregnancy: Perspectives of young women from disadvantaged backgrounds in England Journal of Youth Studies, 9(5), 593–614	A UK Reducing high rates of teen pregnancy “Planning occurs on a continuum”	Mixed 7 sample of 41, 7 pregnant England, White “young mum’s support groups” varied locations	Accounts of “planned” pregnancies: Couple “trying” together or just discussing; women deciding alone; reaction to miscarriage; fears of infertility with injectable birth control. Some “positive ambivalence” Factors in deciding to plan a pregnancy; “Unsettled and volatile” lives, sexual abuse histories; negative school experiences; early parenting “normative” in neighborhood, social circle Explicit reasons “escape route” Alternative to prior lives, independent housing; compensation through wanting to feel loved and caring better for her child; lack of other opportunities as in jobs; proving their competence in mothering; generic preference for parenthood
2006	Rosengard, C., Pollock, L., Weitzen, S., Meers, A., and Phipps, M. G	Public health	Concepts of the advantages and Disadvantages of teenage childbearing among pregnant adolescents: A qualitative analysis Pediatrics, 118(2), 503–510	A Reduce public health consequences of AP—neonatal deaths mentioned Pos. attitudes lead to pregnancy	N = 247 62% of eligible ages 12–19; 17 and under—parental consent First prenatal care visit 47% Hispanic	Advantages (some had none) Connections (love of babies, someone to love or love me, closeness, family and partner support Benefits/positive changes: growth, purpose, happiness, and acceptance Practical considerations: Young and energetic; worried about fertility later, getting pregnancy “over with” Disadvantages (some had none) Lack of preparedness Too young/immature, lack of stability (boyfriend, housing, financial, employment Change/interference Alterations in plans, missing out on “teen years,” life more difficult; more responsibility re changes in appearance Others’ perceptions: Shame (stigma); being seen differently by others Attitudes varied by age, ethnicity, “intendedness” of pregnancy, first or later pregnancy
2007	Hosie, A. C. S.	Unknown	‘I hated everything about school’: An examination of the relationship between dislike of school, teenage pregnancy and educational disengagement Social Policy and Society, 6(3), 333–347	C Locates problem dominantly in bad experiences at school Changes in UK policies mentioned	UK N = 28 pregnant 93 total Recruited at school, interviewed elsewhere	Education Good experiences in primary school except for a quarter who experienced or witnessed bullying. Secondary school only ¼ still liked school; 55% not attending regularly when they conceived. Bullying, falling behind academically Pregnancy. Most encouraged to go to specialty program; some not in school at all. Re-engagement: Many improved attendance while pregnant (2× “good attendance”). Stigma reduction strategy mentioned by some. Working to prevent long-term social exclusion
2007	Shanok, A. F. and Miller, L.	Psychology (counseling psych)	Stepping up to motherhood among inner-city teens Psychology of Women Quarterly, 31, 252–261	A Adds desire to intentions	Mixed methods N = 80, 61 pregnant at the start of the study Black, Hispanic, or both	Path to keeping baby Generally, open though surprised; 36 of 41 had a negative reaction from someone, often moms, who came around in the end. Baby fathers wanted the babies; moms often wanted the preg terminated New ways Fighting reduced, avoided “rough” situations, stopped drinking and drugs, 80% stopped smoking Experiences of disapproval in public, at school, from some family “stigma” Important people. Support from moms and boyfriends—these reduced depression. Babies: “a sacred creations to be protected in a dangerous world” (authors) “I want to live better for my child”
2007	Smythe, L., and Payne, J.	Midwife	Young and pregnant New Zealand College of Midwives Journal, 36, 20–25	A Need to individualize care	New Zealand Sample from midwives and then by snowballing N = 11 ages 15–19 Mixed pregnant and moms, number of pregnant unspecified Some but unknown number of Maori in sample	Coming to accept  Thinking it would not happen  After positive pregnancy test, “now pregnant”  Decision to keep the baby  “Being hit” by reality  Stopping teenage stuff Needing Others  Mothers—scared of reaction, angry when mom not present or caring  Partner—do without if not committed  New friends also pregnant/mothers  Needing money (government)  Needing relationship w midwife BUT Fear judgment Continuing a pregnancy may be more a felt “rightness” than a rational consideration of pros and cons.”
2010	King Jones, E. P.	Nurse	“It drives us to do it”: Pregnant adolescents identify drivers for sexual risk-taking Issues in Comprehensive Pediatric Nursing, 33, 82–100	A Behavioral, personal, and environmental factors	N = 15 Ages 15–19	Drivers for sexual risk-taking: Internal “fitting in,” curiosity, “forbidden fruit” External drivers Partner pressure, pressure from peers (not “square”), media influence (esp. on the boys) Sexual “risk-taking behaviors” were defined as early sexual debut (<13), multiple partners, unprotected sex
2011	Filter, M. S	Human development and family studies (nurse)	Perceived assets of pregnant African American teens: A phenomenological study using asset maps and photovoice DISSERTATION	A Multicultural feminist theory	13 African American pregnant teens Recruited from prenatal clinic Interview X2, asset maps, photovoice, and pictures	Asset #1—unborn child Asset #2—women caring for women Asset #3—family baby’s fathers education as a way out of poverty community members caring for teens Problem—society viewing them negatively
2011	Hulsey, K.P	Education (nurse)	Listening to their voices: A hermeneutic phenomenological study of teen pregnancy DISSERTATION	A	N = 5, 4 Pregnant	Mental and physical stress Relationships Unplanned pregnancy and decisions made Education
2012	Vincent, K.	Unknown	Schoolgirl pregnancy, motherhood and education: Dealing with difference Stoke-on-Kent, England: Trentham Books	C “how educational institutions deal with pupil differences”	UK N = 14, 5 pregnant, 9 already mothers	Chapters: Becoming pregnant: accepting, contraception, planned vs. unplanned, abortion, SRE, views of adolescent vs. adult sex—controversy and discomfort Being a teenage mother mixed thoughts and feelings; challenges, pressures to prove oneself, tensions re dual roles, experiences of child care, stigma, stereotype and shame including differential treatment and responses to it, challenging stereotypes, “us and them” Educational experiences before and after (not detailed here) Perceptions of alternative program (not detailed here) Concluding chapters are “Reframing difference” (helpful and unhelpful results of recognition and non-recognition) Inclusive policy and practice
2013	Knight, C. C.	Nursing	Hard on your heart: A qualitative description of adolescent prenatal stress DISSERTATION	A	N = 11 15–19 Urban, suburban, and rural	Response of family and others to pregnancy Concerns when looking ahead Social and physical changes and plans for future Fears and concerns re safety and support from others
2013	Murphey, C.	Nurse	Oral health experiences of pregnant and parenting adolescent women: A qualitative descriptive study International Journal of Nursing Studies, 50, 768–775	A Goal is to improve dental health behaviors among P/P teens	N = 24 13–21 Mixed—pregnant (n = 7) and parenting (n = 17) Alternative school setting 75% Latina; rest equally white and black	Perceptions of teeth: Pain or no pain, color (white preferred), injuries Knowledge and practices—inconsistent daily oral care, little flossing; feared dental (office) care during pregnancy Myths and misconceptions Fears of bleeding from flossing; washing mouth with milk during pregnancy reduces calcium loss Values—oral health important but barriers in other beliefs
2014	Constantine, N. A., Slater, J. K., Carroll, J. A., and Antin, T. M. J	Public health	Smoking cessation, maintenance, and relapse experiences among pregnant and postpartum adolescents: A qualitative analysis Journal of Adolescent Health, 55, 216–221	A	Mixed N = 52 10 Pregnant 40% Latina Had smoked, had quit during pregnancy	Life-change: “it wasn’t just me anymore”/perception of limited hope for promising future Spontaneous cessation Knew of harms to fetus; nausea sometimes assisted Resistance to postpartum relapse OR Relapse automatic “I’m not pregnant any more” Family smoking a problem Relapse regretted Maintenance postpartum related to lifestyle changes
2014	Rudoe, N.	Sociology	Becoming a young mother: Teenage pregnancy and parenting policy Critical Social Policy, published online July 8, 2014, unpaginated	C UK Poverty biggest problem Working-class parenting “deficit” approach in policy not needed. Many are great mothers Critical feminist approach	Mixed ages 16–20 N = 16 Alternate educational setting Mixed pregnant and parenting White (3), black and mixed race	Responses to government policy Some teens resist government efforts to reduce TP: “it’s my body” “never a bad time to have a baby” Some took too young perspective. Working-class mothering (staff) Traditional hetero middle class family norms invoked Mothering classes: compulsory, not all wanted it Being a good mother Criticized each other for smoking, inappropriate dress, “bad” mothering, denying that they want benefits but will get educated and work Much discussion of “social inclusion” and teen pregnancy policy and social provision
2014	Rudoe, N.	Sociology	School exclusion and educational inclusion of pregnant young women Ethnography and Education, 9(1), 66–80	C Limitations in mainstream and alternate schooling options for pregnant teens Being pregnant in school is a nonschool-based vision of success but an alternate path to adulthood	N = 3 Case studies from larger study.	Problems of inclusion in school for pregnant teens: Case of “bad girl”—acted out in school, sexually active from 13, racism (more punishment that whites), “loud,” outspoken, fighting Case of “ bullied” girl Some experienced physical violence. Case out of school before pregnancy, also rejected by mother Case of teen “thriving in alternative school” (similar problems as Case 1) No parental support in the face of problems at school. Dislike of school common Educational policy and inclusion policy discussed “The young women used pregnancy and educational re-inclusion to make an identity transformation from ‘bad girls’ to ‘good mothers.’
2014	Breen, A. V.	Unknown Department of family relations and nutrition	Changing behavior and changing identity: The case of pregnant and parenting young women Identity: An International Journal of Theory and Research, 14(1), 60–79	A re prior antisocial behavior Problems and sources of positive change lie in the girl Identity formation and behavior change questions	N = 29 14 parenting, 13 pregnant	Changes in behavior: 25 of 27 saw having the baby as positive overall From 15% w no negative behaviors prior to 56% with none in the past year. Subthemes include consequences for the baby and wanting to be a role model. Changing selves—values at 3 points: Independence, self-reliance, honest and truthful dominant vales now, first two in the future as well Contexts for change: changes in relationships w boyfriend, death of friend or family, realization of consequences of violent or risky behavior Change was a process Coherence of narrative key. Age correlated w this. “Identity processes may warrant a closer look “ in working with such teens Prior antisocial behavior means poorer pregnancy and parenting outcomes BUT pregnancy and parenting now known to make positive changes.
2014	Clark, B. S., and Anderson, D. M.	Leisure studies	Not yet a woman, not yet a mom: The leisure experiences of pregnant adolescents Journal of Leisure Research, 46(5), 509–524	A Some personal circumstances affect responses to themes	N = 9 First child, pregnant, and planning to keep infant Site—alternative school	Intentional leisure changes: for health of self/baby (e.g., fewer drugs), teen to pregnant teen, leisure and the role of motherhood (stigma management by not being in public Preparation of baby as leisure: Shopping for baby, baby shower Leisure in motherhood expect to be baby-centered “social death” re other peers Uses Kelly’s narrative types

Data Analysis

For this analysis focusing on authors’ points of view on the problem of teen pregnancy, only some of the information available on each study is presented. Information on each study included in this analysis included the date of publication, the study title, the nature of the manuscript (book dissertation or journal article), a citation to each work so interested readers can find them, the profession of the first author of each study, and the Kelly narrative type that best characterized the study’s approach. As Clemmens (2003) did, no screening for methodological quality was done to be as inclusive as possible.

This study used what Saldaña (2013) calls narrative coding, specifically identifying the “story types” found in each study (p. 135) using three of Kelly’s (1996) narrative types on pregnant teens described above. Specifically, information from the study’s title, stated purpose, introduction, literature review, and its recommendations was used to determine the narrative type. For example, if the recommendations were for education about contraception or addressing mental health needs, it was evidence of a view that the problem resided in the girl, making it Type A. Because a feminist lens was thought to influence how often structural or policy factors (Type C) might be viewed as part of the problem, a stated use of “feminist qualitative methods” or a statement that a feminist point of view informed the study was recorded. Mention of an Afrocentric or race-based approach was also recorded. While mentions of another perspective might occur within a publication, the dominant viewpoint in each study was determined from its topic, literature review, and discussion sections. The summary of themes from the qualitative analysis in each study is given in Table 1 to illustrate the differing types of information presented across narrative types.

Study Findings

The first finding of this study is that it was not a “null review,” meaning that multiple manuscripts were identified that met all of the inclusion and exclusion requirements stated at the outset (N = 38). A summary of selected data from these studies included is given in Table 1, arranged by date of publication from earliest to latest.

Professional Discipline

Social workers were once viewed as the professional experts on teen pregnancy and parenting, but with a public health view of teen pregnancy now predominating, examining the disciplines and professions of the authors of this set of studies seemed useful. The disciplines ³ of the first author of each study were predominantly nursing (n = 18), ⁴ followed by 5 in sociology, 2 in education, and 2 in public health. It was impossible to determine the discipline of the first author in four cases. There was also one study each from medicine, midwifery, social work, family studies, counseling psychology, leisure studies, and public administration. Although this is a small subset of all professional writing on the topic of teen pregnancy, social work research seems to have contributed little to this specific body of work. On the other hand, qualitative research on teen mothers by Wiiliams (1991) and Stevens (1994, 1996), both social workers working from an Afrocentric perspective, is widely acknowledged to have contributed to the emerging idea that teen pregnancy can be a rational choice for low-income women of color and was often referenced in these studies.

Narrative Types: Type A

The Type A is the standard view of professionals and experts on teen pregnancy (Kelly, 1996). Therefore, it is not surprising that the majority of these studies (N = 32; 78%) were classified as reflecting this narrative type. These studies were generally quite sympathetic to the young women described, but their recommendations were almost all focused on services to individual girls. None of the Type A studies referred to social policy as related to the occurrence of teen pregnancy, as framing interventions, or as affecting social provisions.

The topics in the Type A group of studies included a variety of health-related issues. The included sexual risk-taking (King Jones, 2010), how teens understand contraception (Spear, 2004), planned pregnancy (Coleman & Cater, 2006; Montgomery, 2000), prenatal care (Lee & Grubbs, 1995), preterm labor (Mackey & Tiller, 1998), oral health (Murphey, 2013), and smoking cessation (Constantine, Slater, Carroll, & Antin, 2014). Studies like these can be seen as reflecting the now dominant public health perspective on the problem. The other Type A studies focused on psychosocial issues such as emotional distress (Hulsey, 2011; Knight, 2013; Sternebrg & Blinn, 1993); abuse histories (Madigan, Wade, Tarabulsky, Jenkins, & Shouldice, 2014; Renker, 2002]); becoming more “mature,” responsible, or goal oriented (Rentschler, 2003; others); communication with parents (Lloyd, 2004); perceptions of the advantages and disadvantages of teen pregnancy (Rosengard, Pollock, Weitzen, Meers, & Phipps, 2006); social assets and supports (Filter, 2011; Logsdon, 2005); the specific challenges faced by immigrant Puerto Rican teens (Pieve, 2001); and leisure activities (Clark & Anderson, 2014). Further examples can be identified in Table 1.

Narrative Types: Type B

Happily only one study from 1993 was classified as Type B, which had a nurse as author. It should be noted that this study was published early in the time period studied. To illustrate the moralistic base of this point of view, the author of this study commented that the teens interviewed “showed no shame in embarking on single [emphasis mine] motherhood.” While not common among the professional views in this sample of qualitative studies, this “bad family” story remains all-too-well represented in policy and political discourse on the topic. At a time when federal policy was encouraging pregnant teen to consider “adoption as an option,” this study explored pregnant teens’ attitudes toward adoption, which were very negative. Despite the author’s idea that adoption should more often be considered, the young women interviewed believed that their unborn babies would not want to be given away and would never forgive their mothers for doing so. They preferred a nonnormative kind of family for their babies, with an unmarried young mother, rather than a more conventional one. Finally, the study author did not mention how the policy priorities of the Reagan administration were driving efforts at the time to encourage adoption while only funding “abstinence only” rather than comprehensive sex education.

Narrative Types: Type C

There were eight studies (20%) classified as Type C or studies critical of the dominant discourses about teen pregnancy. While examples of this narrative type were found in all decades studied, there were more of them published from 2000 onward. These authors often pointed to changes needed in policy and service organizations, such as schools. As Schonfield (1994) puts it with respect to her sample of pregnant and parenting teens: “development as a mother will be a complicated product of personal strengths and resources influenced heavily by such varied matters as benefit systems and facilities available in the areas in which they live.” Hence, housing, income support, better education prior to pregnancy, better schooling for pregnant and parenting teens in mainstream and alternative settings, and other supports such as infant day care that would permit continuation in school or facilitate employment are needed. As she also observed about social values, “motherhood is valorized but not for the young.” Individual and relationship needs were not overlooked in these studies, but the reverse was not true (recognition of structural challenges and suggestions for change in social provision, social policy, or social change in Type A studies). It should also be noted that half of the Type C studies (n = 4) came from the other countries included in the study.

Mention of feminism as a point of view of the author or a statement that feminist qualitative methods were used occurred in five of the studies under review, 60% of them (n = 3) reflecting a dissenting point of view. An Afrocentric or race-based perspective was mentioned in only two studies, one of them reflecting a dissenting point of view. Counting studies in this way is not fully accurate since two of the feminist studies also mentioned an intersectional view of race and gender. Nevertheless, as Kelly (1996) would have predicted, these perspectives were not dominant in the studies reviewed. Also the evidence of these critical perspectives being related to a Type C classification was equivocal at best.

Narrative types across professions

With exception of the one Type B study and one Type C study, the rest of the studies in nursing were written as part of the dominant Type A professional point of view (18 of 20). By contrast, in social work, there was one Type C study of a total of two; in sociology, three of four studies were Type C, and in studies where the discipline of the first author could not be determined two of four were coded as Type C.

In summary, sociological studies and studies where the author’s profession could not be identified were most likely to reflect the Type C or bad society point of view. This is not surprising since sociology is all about social institutions, such as schools and social structures. One author writing on this topic from the field of education was among those who advocate for school reforms, again not surprising given debates about mainstream or alternative schooling for pregnant and parenting school-age young women and the acknowledgement that school disaffection is related to many problems among teenagers of both genders.

Conclusions and Implications

Before summarizing the findings of this systematic review and analysis, the limitations of the study should be noted. For both feasibility and empirical reasons, this review does not include studies of “parenting” teens. In addition, while studying time and type of publication, the discipline of the first author of each study (but not of all of the authors), the nation in which the study was conducted, and the use of a feminist and/or race-based perspective, there may be unmeasured factors that also affected the type of narrative employed. One of these could be the nature of the qualitative methods used, but the qualitative methods most often were inadequately specified, and there may be others factors as well. However, the first author’s profession, the country of study, and the use of a feminist or race-based perspective did seem to be relevant to the researchers’ points of view on the problem.

The first finding was that there was much available qualitative research conducted on pregnant teens in the 25-year-period studied (and even more on teen mothers). The range of topics addressed in these studies is great. These studies are useful resources for informing practitioners and researchers about the wide range of issues involved in teenage pregnancy. As Luker (1996) has observed, the politics and policy-making surrounding teen pregnancy are rarely based in the realities of young mothering today, and qualitative research is an important source of evidence of what is really going on in the lives of young mothers-to-be. Identifying the different stories about teen pregnancy as Kelly (1996) has done illuminates the ideological bases f often-misguided policies (Breen, 2014).

There are some issues unique to pregnant versus parenting teens, such as fears about delivery or responding to preterm labor, as compared to teenage mothers. In addition, pregnant teens are speaking about what they intend to do as mothers, but they have not yet faced the daily “grind” of providing 24-hr safety and care for their babies. However, qualitative studies of pregnant and parenting teens show many commonalities. Perhaps most important is the view that a first pregnancy is a life transition, a rite of passage into adulthood, and a life-changing event that has the potential to move teens toward taking more responsibility, reengaging on schooling, and withdrawing from the riskier ways of living (“partying,” marijuana use) that preceded the pregnancy.

It was also found that different stories were told in the studies reviewed based on Kelly’s (1996) classification of narratives. The majority of studies took the prevailing expert point of view of studying the problems as residing in the girl, even as the range of individual problems, from better knowledge about contraception to addressing the effects of traumatic experiences like sexual abuse, is broad. Pregnant teens often do have personal problems and/or unmet needs, and a pregnancy can create additional problems for them, although many can be ameliorated with proper support and care. Attention to these issues at the individual and family level is needed. However, it is unclear whether the “urgent” social problem of teen pregnancy can be solved by attention only to the range of felt or documented needs of individuals.

Interestingly, no study mentioned proven early intervention methods that follow mothers and infants from pregnancy through early childhood and that have been shown to improve birth outcomes, lower the incidence of developmental and other problems for the infants including child abuse, and prevent teen pregnancy and other social problems years after the intervention took place. Mothers receiving such services also benefit from being encouraged to continue with educational preparation for better earnings and opportunities in the future.

Those writing about teen pregnancy from a dissenting point of view (Type C in this analysis) are fewer in number, but their analyses deserve attention as well. Structural problems like poverty and discrimination are difficult to address in the current neoliberal climate (as they have always been). Advocacy for measures to reduce poverty and its disproportionate prevalence among women in communities of color must continue. In addition, there is much evidence that “regular” schools often push disadvantaged young women out before and after they become pregnant, and there are questions about the quality of the education that young women receive in some alternative programs as well. Meaningful and progressive reform of our educational systems will have to ensure that there is inclusion and adequate support for all kinds of “different” students, including pregnant teens. Social workers in school settings are well positioned both to advocate for individual teens and to encourage needed system change.

From a feminist and intersectional point of view, structural issues like sexism, racism, and poverty must be addressed. In some of these studies, teens reported what they perceived as unequal treatment based on race or ethnicity; in an unpublished qualitative study (Payne, Anastas, & Ghuman, 2016), teens were very aware that employers were reluctant to hire them while pregnant based on that factor alone. They also knew that most of the jobs available to them could best be described as “dead end” ones. Many studies in this review also recorded observations from teens that they “hated school” and experienced insult and harassment in the school context. While supportive interventions with individuals can help pregnant teens remain in school or prepare for better employment, quality and inclusive education and quality jobs are generally in short supply in their neighborhoods and communities. Larger scale social changes will likely be necessary for these resources to improve.

Prevention of teen pregnancy remains a policy and public health priority, and all teenage women who are sexually active deserve access to the full range of reproductive health-care services that they may want. However, given expectable human sexual desires, it is unlikely that complete eradication of teenage pregnancy and childbearing will ever be achieved even in the most affluent nations, although rates in the United States can surely be further reduced. Evidence-based programs providing early intervention and support to low-income mothers at risk, including teens, have been shown to improve outcomes for both mothers and children, an example being the Nurse–Family Partnership program, now used in over 20 states. Such programs need to be more widely implemented. However, these programs were not mentioned as a recommendation in the Type A studies, suggesting that more professionals need to be aware of and engaged in these proven early intervention efforts.

Finally, with respect to the social work profession, only two studies among those retrieved had a social worker as the first author. One of the two studies expressed a “dissenting” point of view, reflecting our profession’s social justice commitments. Although the studies reviewed here represent only one narrow set of research studies on the topic of teen pregnancy, this absence is perhaps worrisome, given the history of social work concern with this issue. This is not the only field of research and practice identified in the past with social work in which nursing is expanding its interest and activity. Teen pregnancy, while declining in incidence, is still a field with which those in many professions should be involved. For those of us concerned with gender, race, health disparities, income inequalities, and oppressions, this is a point to ponder.